Aging Begins at 30

Dizziness

Creation Date: June 2000
Last Revision Date: June 2000
Peer Review Status: Internally Peer Reviewed

If you ask a family physician, a neurologist, an otolaryngologist, a psychiatrist or an internist, "what is the main cause of dizziness in the elderly?" you will get a different answer from each.

Dizziness occurs in about 25% of the elderly, though different studies put the range from 13% to 38%. Dizziness is a very important indicator because it leads to falls and to nursing home placement, sometimes followed by stroke or death.

Now we have a definitive study. Not an examination of dizzy people attending an otolaryngology clinic or a neurology clinic but a probability study of 1,087 community living persons, looking for dizziness, in persons aged 72 or older. They lived in New Haven, Connecticut, and are reported by Dr. Mary Tinetti and her colleagues at Yale in the March issue of the Annals of Internal Medicine.

*Twenty four percent of the sample (261 persons) reported dizziness of a month or longer duration. Dizziness had lasted for a year or more in two thirds of that group. About half reported several different sensations lumped as dizziness such as loss of balance, unsteadiness, perception of motion, near fainting etc.

*Three quarters had precipitating or triggering events.

* About 40% more of the dizzy patients, than the 826 controls without dizziness, complained of one or more of seven problems such as anxiety, depression, deafness, low blood pressure on standing, poor balance, former heart attacks or multiple medicines (5 or more). These same problems have been described as probable main causes of imbalance in prior studies.

These investigators state that dizziness, like falls, delirium, and urinary incontinence, has no one cause. Dizziness therefore qualifies as a "geriatric syndrome" and may be amenable to an impairment reduction strategy. I believe this means to treat all impairments one after another in order to assess the contribution of each factor.

Multiple domains in the body contribute to a person's stability. It appears that treatment has to be directed successively at factors contributing to dizziness such as depression, middle ear disease, deafness or muscle weakness. So don't make a pinpointed diagnosis but list the contributing factors and deal with them in sequence.

To help guide your doctor to a logical sequence of diagnostic tests think well about what you are calling dizziness. For example is it lightheadedness or faintness, like the feeling of getting up suddenly from weeding the garden? Is it the feeling you get when you stop turning round and round? Or yet again is it difficulty in catching yourself like tripping on an uneven sidewalk or carpet? Can you describe how long it lasts? Because the causes of momentary dizziness are different from the causes of prolonged dizziness. Do you have the uncommon problem when for hours or days you dare not move your head for fear of vertigo type dizziness, nausea, and vomiting? Answers to these questions are a big help in planning an approach to this very common problem.

Treatments are available for these problems and may be as simple as a hearing aid or regular planned exercise. This new study suggests that the elderly dizzy patient's physician should not necessarily stop at treating only one causative factor but should plan to find and treat several probable causes. Confirming studies are needed.

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See related Patient Topics Brain and Nervous System, Dizziness and Vertigo, Ear, Nose and Throat or Symptoms and Manifestations.

See related Provider Topics Brain and Nervous System, Dizziness and Vertigo, Ear, Nose and Throat or Symptoms and Manifestations.

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