The Clínica Universidad de Navarra has reported that its Otolaryngology Service is putting in place a specific assessment protocol for people over 65 years old, in which different balance and physical condition tests are combined with the aim of identifying frailty at an early stage.
"Two patients of the same age and with apparently similar vestibular symptoms can have very different physical abilities and risks," the Doctor in Physical Therapy and member of the center, Laura Flix, has indicated. She added that knowing from the beginning each person’s functional situation "makes it possible to identify who may need more specific care during their recovery."
The first data obtained with this new procedure under development at the Clínica Universidad de Navarra indicate that close to 70 percent of the patients analyzed would be in a state of pre-frailty or frailty, which underscores the relevance of assessing functional status beyond vestibular symptoms.
In a scenario in which episodes of vertigo, dizziness, or instability in older people are often associated with less muscular strength, less endurance, or poorer functional capacity—factors that increase vulnerability during the recovery process—the protocol incorporates specific physical tests and the use of accelerometers to objectively measure different movement parameters.
Identifying vulnerabilities and personalizing Physical Therapy
Thanks to this combination of tools, information is obtained that facilitates the detection of vulnerability factors and helps to design vestibular Physical Therapy that is better suited to each case. One of the tests used is the "Short Physical Performance Battery", considered a valid and reliable tool for analyzing physical performance in people over 60 years of age. A review of 28 studies showed good or excellent reliability levels, while another analysis of 40 longitudinal studies linked poorer performance on this battery with various adverse events and, in most cases, with an increase in mortality risk.
The Otolaryngology and Vestibular Physiotherapy team at the center has already reported in 2025 that vestibular rehabilitation improved the quality of life in more than 89 percent of the patients treated in the previous year who were evaluated on this parameter. In that study, 109 people were referred to Vestibular Physiotherapy and 37 performed in-person therapeutic exercises with subsequent follow-up.
The approach begins with the vestibular examination carried out by Otolaryngology and continues with a functional assessment carried out by Physiotherapy. The goal is to recover not only balance, but also functionality, autonomy, and quality of life. Detecting situations of pre-frailty or frailty makes it possible to know the physical reserve with which each patient faces their recovery and to adjust the therapeutic plan to their characteristics.
"We want to move from knowing what balance problem the patient has to getting to know better the person in front of us: how is their strength, their endurance, and their functional capacity," Flix has said, adding that this "allows for a more specialized and individualized approach." The second edition of the course "Fundamentals of Vestibular Physiotherapy," organized by Clínica Universidad de Navarra, from November 13 to 14, will delve further into these issues.