How to manage dizziness and prevent falls in elderly individuals?

Managing Dizziness and Preventing Falls in Elderly Individuals

Multifactorial risk assessment with comprehensive management is the most effective approach for preventing falls in elderly individuals experiencing dizziness. 1

Initial Assessment

• Identify older adults at increased risk for falls by assessing history of falls, problems in physical functioning, and limited mobility 1
• Evaluate gait and balance using standardized tests such as the Timed Up and Go test 1
• Conduct a comprehensive fall risk assessment including evaluation of:
  • Gait and balance disorders 2
  • Postural hypotension (measure blood pressure supine and after 1-3 minutes of standing) 3
  • Medication review (especially those that increase fall risk like vasodilators, diuretics, antipsychotics, and sedatives) 3
  • Environmental hazards 2
  • Sensory impairments 2

Classifying Dizziness

• Categorize dizziness into one of four types to guide management: 4
  • Vertigo (spinning sensation) - Consider benign paroxysmal positional vertigo (BPPV), Meniere's disease, vestibular neuritis, or labyrinthitis 5
  • Presyncope (feeling faint) - Often related to orthostatic hypotension or medication side effects 4
  • Disequilibrium (unsteadiness when walking) - Consider Parkinson's disease or diabetic neuropathy 4
  • Lightheadedness (vague sensation) - May be related to psychiatric disorders or hyperventilation 4

Evidence-Based Interventions

Exercise Interventions

• Implement individually tailored exercise programs administered by qualified professionals focusing on: 1, 2
  • Balance training
  • Gait training
  • Lower extremity strength exercises
  • Transfer skills training
• T'ai chi classes with individual instruction are effective for reducing falls in unselected older adults 1, 2
• Exercise interventions should typically include:
  • 3 sessions per week for at least 12 months 1
  • Gait, balance, and functional training 1
  • Resistance training 1
  • Flexibility exercises 1

Environmental Modifications

• Conduct occupational therapy assessment at home with direct intervention, advice, and education 1, 2
• Implement environmental modifications based on identified hazards 2
• Home assessment alone without follow-up interventions or referrals is ineffective 2

Medical Management

• Review and modify medications that may contribute to falls, especially those causing orthostatic hypotension 3
• Address postural hypotension if present 2
• For vertigo:
  • Perform the Epley maneuver (canalith repositioning) for BPPV 5
  • Consider vestibular rehabilitation exercises 5
  • For Meniere's disease, recommend salt restriction and diuretics 5
  • For vestibular neuritis, consider steroids 4
• For orthostatic hypotension causing presyncope, consider alpha agonists, mineralocorticoids, or lifestyle changes 4

Multifactorial Approach

• Implement comprehensive management targeting multiple risk factors simultaneously 1
• Components of effective multifactorial interventions include:
  • Exercise programs 1
  • Medication management 1
  • Treatment of postural hypotension 2
  • Vision assessment and correction 1
  • Home safety assessment and modification 1
  • Education about fall prevention 1

Common Pitfalls to Avoid

• Implementing single-component interventions, which are less effective than multifactorial approaches 2
• Providing home assessment without follow-up interventions or referrals 2
• Failing to tailor interventions to the individual's specific risk profile 2
• Not involving qualified professionals to administer exercise programs 1, 2
• Overlooking that dizziness in older adults may represent atypical presentation of syncope 3
• Ignoring that multiple etiologies for falls often coexist in older adults 3

Special Considerations

• Cognitive impairment can reduce the accuracy of symptom recall in older adults 3
• "Unexplained" dizziness in older adults may be related to distorted perception of instability and subtle impairments in balance control 6
• Concerns about falling can lead to overly cautious postural responses and increased risk of falls 6