From the Guidelines
Dizziness in the elderly is commonly caused by several conditions, including benign paroxysmal positional vertigo (BPPV), medication side effects, orthostatic hypotension, vestibular disorders, and cardiovascular issues, as supported by recent clinical practice guidelines 1. The causes of dizziness in the elderly population can be multifactorial and may involve various systems, including the vestibular, cardiovascular, and neurological systems.
- BPPV occurs when calcium crystals in the inner ear become dislodged, causing brief spinning sensations with head movements, and is a common cause of dizziness in the elderly, with a prevalence of 36.7% in a study of 120 elderly patients with chronic vestibular disorders 1.
- Many medications taken by older adults, such as antihypertensives, diuretics, sedatives, and antidepressants, can cause dizziness as a side effect, and medication adjustments may be necessary to alleviate symptoms 1.
- Orthostatic hypotension, a sudden drop in blood pressure when standing up, is particularly common in the elderly due to age-related changes in blood pressure regulation and medication effects, and can increase the risk of falls 1.
- Vestibular disorders affecting the inner ear's balance system, including vestibular neuritis and Ménière's disease, can cause persistent dizziness, and management typically involves treating the underlying cause, medication adjustments, vestibular rehabilitation exercises, and implementing safety measures to prevent falls 1.
- Cardiovascular problems like arrhythmias, heart valve disease, and carotid artery stenosis may reduce blood flow to the brain, resulting in lightheadedness, and other contributing factors include dehydration, anemia, low blood sugar, neurological conditions like Parkinson's disease, and vision problems 1. Therefore, a comprehensive evaluation and management plan are necessary to address the underlying causes of dizziness in the elderly population and prevent falls, which are a serious risk for dizzy elderly patients 1.
From the Research
Causes of Dizziness in the Elderly Population
The causes of dizziness in the elderly population can be attributed to various factors, including:
- Benign paroxysmal positional vertigo (BPPV), which is the most common cause of vertigo in older adults 2, 3, 4, 5
- Hyperventilation/anxiety, which is also a common cause of dizziness in the elderly 3
- Age-related degenerative processes that affect balance, including presbystasis (the loss of vestibular and balance functions associated with aging) 6
- Vestibular agnosia, which is an impaired vestibular perception of self-motion and can result in dramatically increased missed BPPV diagnoses 5
- Stroke, which can cause dizziness and vertigo in acute syndromes 6
- Medication side effects, such as those associated with meclizine, which is commonly prescribed for BPPV 4
- Vitamin D deficiency and osteoporosis, which may be associated with an increased risk of BPPV 4
Diagnostic Considerations
Diagnosing the cause of dizziness in the elderly can be complex, as patients may report less rotatory vertigo and more non-specific dizziness and instability than younger patients 6. Diagnostic tests, such as the Dix-Hallpike and Head Roll tests, can help identify the involved canal and diagnose BPPV 4. Positional testing should be considered for all older adults with objective or subjective balance problems, irrespective of symptomatic complaint, to examine for BPPV 5.
Treatment and Management
Treatment for BPPV typically involves specific therapeutic maneuvers, such as the Epley maneuver, which can expedite recovery and reduce the burden of the disorder 2, 4. However, in older patients, BPPV may respond less effectively to treatment and have a tendency for recurrence 2. A multidisciplinary approach, considering the needs of older adults with vertigo, is essential for effective management 4, 5.