Pain and anxiety mediate the relationship between dizziness and falls in older people

J Am Geriatr Soc. 2013 Mar;61(3):423-8. doi: 10.1111/jgs.12131. Epub 2013 Jan 25.


Objectives: To identify medical, psychological, and physiological mediators of the relationship between dizziness and falls in older adults.

Design: Secondary analysis of a prospective cohort study.

Setting: Community.

Participants: Five hundred sixteen community-dwelling adults aged 73 to 92.

Measurements: Participants completed questionnaires related to health and psychological well-being and underwent a tilt table blood pressure test, the Physiological Profile Assessment (PPA; vision, reaction time, proprioception, postural sway, and quadriceps strength), and leaning balance tests. Prospective falls data were collected using monthly calendars for 12 months. Participants were categorized into dizzy and nondizzy groups based on self-report of dizziness, vertigo, and light-headedness.

Results: Two hundred seventeen (42%) participants reported vertigo or dizziness (10%), light-headedness (16%), or both (16%). The dizzy participants were significantly more likely to report neck and back pain, past transient ischemic attacks, and feeling dizzy upon upright tilting. They also had poorer balance and less strength and scored higher on measures of depression and anxiety (P < .05). There were no blood pressure measurement-related differences between the groups. Dizziness increased the risk of multiple falls in an unadjusted analysis (relative risk (RR) = 1.55, 95% confidence interval = 1.08-2.23). After controlling for PPA scores, neck and back pain and anxiety were mediators that reduced the RR of the relationship between dizziness and faller status the most (14%) in a modified Poisson regression model.

Conclusion: Suffering from neck and back pain and anxiety were mediators of the relationship between dizziness and falls after controlling for poor sensorimotor function and balance. Older people with dizziness might benefit from interventions targeting these mediators such as pain management and cognitive behavioral therapy.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Accidental Falls / prevention & control*
  • Accidental Falls / statistics & numerical data
  • Aged
  • Aged, 80 and over
  • Anxiety / epidemiology*
  • Anxiety / therapy
  • Back Pain / epidemiology
  • Cognitive Behavioral Therapy
  • Dizziness / epidemiology*
  • Dizziness / psychology
  • Dizziness / therapy
  • Female
  • Humans
  • Male
  • Neck Pain / epidemiology
  • New South Wales / epidemiology
  • Pain / epidemiology*
  • Pain Management
  • Poisson Distribution
  • Prospective Studies
  • Recurrence
  • Regression Analysis
  • Risk
  • Vertigo / epidemiology