Physical, psychological and clinical predictors of falls among middle-aged and older community-dwelling adults with dizziness

Introduction: Dizziness is a common complaint with many of its underlying contributors overlapping with established risk factors for falls. This secondary analysis examined the fall‑risk profiles of middle‑aged (50–64 years) and older (≥65 years) community‑dwelling adults who reported significant dizziness.

Method: 305 community‑dwelling adults aged ≥50 years with dizziness were recruited as part of a randomised controlled trial. Participants completed questionnaires assessing demographics, dizziness severity, medication use, and psychological health, alongside an evaluation of sensorimotor function, orthostatic hypotension, balance, and gait. Falls were tracked prospectively over six months using monthly fall diaries. Modified Poisson regression analyses, controlling for group allocation, were conducted to compare fallers (≥1 fall) with non‑fallers (0 falls).

Results:  Twenty‑five percent of participants reported 215 falls over the follow‑up period.  There were 19% and 29% of fallers in the middle‑aged group (n=106) and the older group (n=199), respectively. Polypharmacy (≥4 medications) and reporting multiple falls in the previous year were significant predictors of falls in both age groups (RR>1.5, p<0.005 for all). Among middle‑aged adults, slow walking speed (<0.1 m/s) (RR=2.90 [1.32–6.46]), a high sensorimotor composite fall‑risk score (RR=3.28 [1.42–7.26]), and use of psychotropic medications (RR=2.97 [1.42–6.24]) were additional significant risk factors. Among older adults, orthostatic hypotension (RR=1.93 [1.25–2.96]), high concern about falling (RR=1.72 [1.12–2.65]), and use of nervous system medications (RR=1.60 [1.03–2.47]) were additional significant risk factors. Neither vestibular diagnosis nor the frequency or severity of dizziness symptoms was associated with increased fall risk.

Conclusion: Middle‑aged and older adults with dizziness exhibit distinct fall‑risk profiles: physical impairments and psychoactive medication use in middle‑aged adults, and orthostatic hypotension and heightened concern about falling in older adults. Implementing evidence‑based interventions that address the underlying causes of dizziness may help reduce fall risk in adults aged 50 years and older.