From the Guidelines
Scopolamine patches should be used with extreme caution in a 90-year-old male with vertigo due to the high risk of anticholinergic side effects in elderly patients. The use of scopolamine patches for vertigo is based on their ability to block acetylcholine, a widespread CNS transmitter, which helps reduce neural mismatching and alleviate motion sickness symptoms 1. However, the standard transdermal scopolamine patch (Transderm Scōp) delivers 1.5 mg over 72 hours and should be placed behind the ear on clean, dry, hairless skin, with the patch applied 4 hours before symptom control is needed.
Some key considerations for using scopolamine patches in a 90-year-old male include:
- Close monitoring for anticholinergic side effects such as confusion, urinary retention, dry mouth, blurred vision, and constipation, which may be more pronounced in elderly patients 1.
- Potential need to consider alternative treatments like meclizine, which might be safer in this age group if scopolamine causes adverse effects.
- Ensuring the patient or caregiver understands proper application technique, hand washing after handling the patch, and when to seek medical attention for side effects.
- The patch can be worn for up to 3 days before replacement is necessary, but careful assessment of the patient's response and side effects is crucial in this age group.
Given the potential risks, it is essential to weigh the benefits of scopolamine patches against the potential for adverse effects in elderly patients, and to consider alternative treatments that may have a more favorable safety profile 1.
From the Research
Vertigo Treatment in Older Adults
- The treatment of vertigo in older adults, such as a 90-year-old male, should consider the potential for interactions with other medications and the risk of preventing the development of central compensatory mechanisms 2.
- Vestibular rehabilitation therapy (VRT) is a recommended treatment for vertigo, as it promotes vestibular adaptation and substitution, and can be effective in improving gaze stability, postural stability, and activities of daily living 3.
Scopalamine Patches
- There is no direct mention of scopalamine patches in the provided studies as a treatment for vertigo in older adults.
- However, the studies suggest that vestibular rehabilitation and physical therapy are strongly advised and rarely contraindicated for patients with vertigo, including older adults 2, 3, 4, 5, 6.
Considerations for Older Adults
- Older adults with vertigo may have multiple comorbidities and be taking several medications, which should be considered when choosing a treatment 2.
- The "Dizziness Handicap Inventory Scale" may be used to establish the extent of the dizziness problem and identify risk factors for recurrent dizziness 4.
- Vestibular and balance rehabilitation with an interdisciplinary collaboration should start rapidly to avoid psychosocial complications, such as fear of falling 4.