Dizziness is a major cause of falls in seniors and is one of the reasons falls are more common as age increases. Falls in seniors account for a large portion of disabling injuries and hospitalizations. Falls may lead to hip fractures, bruises, fear of falling again, increasing immobilization and deconditioning, and finally institutionalization. One year after a hip fracture 23.6 per cent of women and 33 per cent of men died. Four years after the date of the hip fracture, the death rates in women and men were 44.4 per cent and 55.3 per cent respectively.
Your physician may ask you these questions to determine the type and cause of your dizziness:
There are three segments to the system that maintains a stable upright posture: one, the vestibular labyrinth in the inner ear; two, good vision; and three, intact brain function (brain stem, cerebellum, cerebral cortex, spinal cord, and sensory input especially from joints). All of these functions change with age, making seniors more predisposed to dizziness.
Dizziness, lightheadedness, dysequilibrium and unsteadiness are very vague symptoms, but a good history, physical examination and laboratory work-up can help the family physician identify the problem.
There are four main categories of dizziness that can be identified in the senior dizzy patient by taking a good history. There are:
Type 1 True Vertigo is a feeling of disorientation in space, combined with a sensation of motion. The motion is always rotary in nature. True sense of rotation may have nausea and vomiting,tinnitus (ringing in the ears), sweating, difficulty maintaining balance, and may fall during an episode of vertigo. True vertigo can be separated into central and peripheral vestibular dysfunction. Central vestibular lesions were found in 50 per cent and peripheral lesions in 34 per cent of the elderly referred to a vestibular clinic.3
Central lesions in the brain are common causes of vertigo in the elderly. Strokes and tumors can cause dizziness. Proper control of blood pressure is important in preventing strokes. Medication such as a blood thinner (couradin sintrom) may be needed for preventing some types of stroke.
This causes a sensation of feeling faint, as if a blackout may occur. Type II Lightheadedness is due to impaired quality or quantity of blood going to the brain. Low blood sugar in someone with diabetes is one of the important causes of poor quality of blood being supplied to the brain. Irregular pulse may reduce the quantity of blood to the brain. The patient may need an ECG or 24-hour Holter tape to monitor the heartbeat for irregularities. Medication may cause the blood pressure to drop on standing. If the drop is too great, there may be inadequate blood flow to the brain.
To make this diagnosis, the doctor will check the blood pressure lying, sitting and standing. If there is a drop exceeding 30 mmHg systolic and 15 mmHg diastolic, we say the patient has postural hypotension. This problem often requires a medication adjustment.
The patient complains of a dizzy feeling associated with anxiety. The individual may describe shortness of breath or hyperventilation and may have a psychiatric disorder. Deep breathing for three minutes reproduces the symptoms. This disorder is not common in the elderly. Type III anxiety and depression can cause the symptoms of dizziness. It is important to treat these conditions if they occur.
This dizziness is characterized by a feeling of unsteadiness, not vertigo, but a perception of difficulty maintaining balance when walking or turning. This is most common in frail older persons. The senior patient will describe a disturbance in gait or difficulty with balance.
Often there are many reasons for this unsteadiness. There are sensors in the joints of the cervical spine (neck) which are important for posture control. Dizziness associated with head rotation may be caused when these receptors aren’t working properly. These patients may feel worse with a restricted cervical collar. They should be prescribed exercises to improve the range of neck movements and they must learn to rely more on vision.
Circulation problems in the base of the brain (vertibrobasilar ischemia) is suggested by evidence of brain stem dysfunction trouble speaking, double vision, numbness around the mouth and limb paralysis. Poor vision from cataracts or retinal damage can contribute to impaired balance. Drugs and medication which dull brain function can impair walking and balance. Examples include alcohol, benzodiazepines, sleeping medication and antianxiety pills. The family doctor can evaluate motor strength, balance sensation, joint function, hearing and vision in the elderly patient.
By understanding the cause of dizziness, your doctor can take steps to help manage the problem. Education will help those with ongoing problems to cope with their disability. Sometimes there is no cure for the dizziness, but it is always important for a person to understand their limitations and to get help to maximize their quality of life.
Occupational therapy can help to prevent falls in the home, through grab bars in the bathroom and raised toilet seats. Physiotherapy can improve motor strengthening and instruct in the use of walking aides (cane or walker) and gait training. Your family doctor can review medication, treat anemia, manage irregular heart beat and advise about alcohol avoidance and continue monitoring your medical condition.
Much can be done to help a person suffering from this often frustrating and sometimes dangerous condition. Help can begin with a trip to your family doctor.