Implementing Vestibular Symptom Screening To Enhance Falls Prevention In Older Adults In A Post-Acute Rehabilitation Setting

Introduction: Falls are a leading cause of morbidity among older adults, particularly in post-acute rehabilitation settings characterised by multimorbidity and functional decline. The World Guidelines for Falls Prevention and Management for Older Adults (2022) recommend comprehensive, person-centred multifactorial falls risk assessment (MFRA), including evaluation of balance and vestibular function. However, vestibular symptoms are frequently under-recognised in routine practice.

Objective: To implement and evaluate a structured vestibular symptom screening process within a physiotherapy-led falls prevention pathway in an Irish post-acute rehabilitation hospital, to improve identification of vestibular-related falls risk and support individualised intervention planning.

Method: A six-month quality improvement initiative was conducted in a post-acute rehabilitation hospital. A brief vestibular symptom screening tool (VSST), capturing dizziness characteristics, positional triggers, and imbalance history, was embedded within the standardised MFRA. Physiotherapists received targeted training. Screening uptake, prevalence of vestibular symptoms, and referral patterns were recorded. Patients scoring ≥4 on the VSST were referred for vestibular assessment. Demographic data, Clinical Frailty Scale (CFS), Timed Up and Go (TUAG), Five Times Sit-to-Stand (5xSTS), and VSST scores were extracted from local data systems.

Results: Screening uptake reached 96.3% of eligible admissions (n=785). Vestibular symptoms were identified in 5.7% of patients (n=45), with a 200% increase in appropriate vestibular assessment referrals following implementation. Mean age was 76.4 years in the VSST ≥4 cohort and 78.2 years in the VSST <4 cohort. Median CFS was very mildly frail in both groups. TUAG times were comparable, while 5xSTS performance was slower in the VSST ≥4 cohort (38.69 vs 30.34 seconds). Clinicians reported increased confidence in identifying vestibular contributors to falls risk.

Conclusion: Routine vestibular symptom screening within MFRA is feasible, acceptable, and clinically valuable in post-acute rehabilitation. Vestibular-related falls risk may not be detected using routine outcome measures alone. This initiative supports guideline-aligned high-risk case finding and individualised, multidomain falls prevention strategies.