Dizziness is a major cause of falls in seniors. It is one reason falls become more common with age. For seniors, falls account for a large portion of disabling injuries and time spent in hospital. Falls may lead to hip fractures, bruises, fear of falling again, and less mobility and physical fitness. After falling, a senior may have to be cared for in an institution. Sadly, death is another possibility.

Investigating dizziness

A doctor may ask the following questions to determine the type and cause of dizziness.

Can you describe your symptoms without using the word dizzy?
Is the dizziness associated with feeling faint or a sense of blacking out?
Do you have a tendency to fall?
Do you lose your balance while walking?
Is there a sensation that the world is spinning or that you are spinning?
Does your position affect your symptoms? Does getting up from bed or a chair to an upright position make the dizziness worse? Does rolling over in bed make you dizzy?
Do you have headaches?
Is the dizziness constant or does it come and go? What makes it start or get worse? Can you stop the dizziness?
Do you have allergies?
Do you use tobacco or alcohol? Do you use prescription or non-prescription drugs, especially sleeping medications, or medications for anxiety, depression, or high blood pressure?
Has your hearing changed?
Does being anxious bring on dizziness or make it worse?
Do you have other symptoms with the dizziness, like nausea and vomiting, weakness in your limbs, or double vision?

Explaining dizziness

There are three parts of the vestibular system, which helps us maintain balance and stable upright posture. The first is the vestibular labyrinth in the inner ear. Good vision is the second. The third is intact brain function. (Parts of the brain and the spinal cord are involved in brain function. It also incorporates sensory input, especially from the joints.) All of these change with age, making seniors more at risk for dizziness.

Dizziness, lightheadedness, dysequilibrium and unsteadiness are very vague symptoms. However, a good medical history, physical examination and laboratory work-up can help the family doctor identify the problem. Dizziness falls into four main categories:

Type I – true vertigo
Type II – lightheadedness
Type III – anxiety
Type IV – dysequilibrium.

True vertigo (Type I)

True vertigo is a feeling of being disoriented in space. It is combined with a sensation of motion. The motion is always rotary in nature. True sense of rotation may involve nausea and vomiting, tinnitus (ringing in the ears), sweating, and difficulty maintaining balance. An episode of vertigo can cause a fall.

True vertigo can affect the central nervous system, or its periphery (the area bordering it). Half of the seniors examined in a balance clinic had central vestibular lesions. Another third had peripheral vestibular lesions.

Central lesions in the brain commonly cause vertigo in the elderly. Strokes and tumors can lead to dizziness. Proper control of blood pressure is important in preventing strokes. Medication like blood thinners may be needed to avert some types of stroke.
Peripheral lesions (inner ear problems)

Acute viral labyrinthitis is a common disorder. It is caused by a virus and will clear up on its own. Usually, spells of vertigo involve a sensation of spinning or rotating, or that the world is spinning. Nausea and vomiting resolve in a few days. Some imbalance may last for a few weeks. Hearing loss is temporary. When no hearing loss occurs, the disorder is called vestibular neuronitis.

Benign positional vertigo is a frequent cause of dizziness in the elderly. Intense vertigo is brought on by movement, such as rolling over in bed. Symptoms last a few seconds to less than a minute, and then resolve quickly. In this case, debris stimulates the semicircular canal in the inner ear when the head turns to a certain position. The condition is harmless. A physiotherapist may be able to help reduce the uncomfortable symptoms.

Meniere’s disease is chronic, coming and going. It may last a few minutes to 24 hours and can recur weekly, monthly or yearly. Low tone hearing loss may come along with vertigo symptoms. Anti-vertigo medications (Bonamine™, Antivert™) can help reduce some vertigo symptoms. In severe cases, surgery may be an option.

Lightheadedness (Type II)

Lightheadedness is a sensation of feeling faint, as if about to pass out. It is due to impaired quality or quantity of blood going to the brain.

Low blood glucose in those with diabetes and anemia commonly results in poor quality blood being supplied to the brain.
An irregular pulse may reduce the quantity of blood to the brain. Tests such as an electrocardiogram (ECG) can monitor the heartbeat for irregularities.
Medication may cause blood pressure to drop when a person stands. If the drop is too great, too little blood may flow to the brain. To make this diagnosis, the doctor will take blood pressure readings as the senior lies down, sits and stands. A drop of more than 30 mm Hg systolic and 15 mm Hg diastolic confirms postural hypotension. Adjusting medication may solve the problem.

Anxiety (Type III)

In this condition, the dizzy feeling is associated with anxiety. Shortness of breath or hyperventilation can accompany it. Deep breathing for three minutes will reproduce symptoms. This disorder is not common in the elderly. A psychiatric disorder is possible.
Type III anxiety and depression can cause symptoms of dizziness. It is important to treat these conditions.

Dysequilibrium (Type IV)

This dizziness is characterized by a feeling of unsteadiness rather than vertigo. It is difficult to stay balanced when walking or turning. This is most common in frail older people. The senior will describe a change in walking or difficulty with balance. Several possibilities may explain this unsteadiness.

Sensors in the joints of the spine in the neck help with posture control. If these sensors are not working properly, dizziness may come when the head turns. Those with this problem may feel worse with a restricted cervical collar (which goes around the neck). Exercises to improve the range of neck movements are recommended. Relying more on vision is necessary.
Trouble speaking, double vision, numbness around the mouth, and limb paralysis are signs of brain stem dysfunction. They suggest blood circulation problems in the base of the brain.
Poor vision from cataracts or damage to the retina can affect balance.
Drugs and medication that dull brain function can interfere with walking and balance. Alcohol, benzodiazepines, and medications that assist with sleep and anxiety can all have an effect.

Getting help

Determining the cause of dizziness allows the family doctor to help manage the problem. Motor strength, sense of balance, joint function, hearing and vision will be evaluated. The doctor can review medications, treat anemia, manage an irregular heartbeat, suggest avoiding alcohol, and monitor medical conditions.

An occupational therapist can help to prevent falls in the home by suggesting aids like grab bars in the bathroom and raised toilet seats. Physiotherapists work with seniors to improve motor strength and provide instructions on using walking aides, such as a cane and walker.
Education helps those with ongoing problems to cope. Sometimes, dizziness cannot be cured. Understand the limitations caused by dizziness, and get advice on maintaining and improving quality of life.

Many measures can help someone suffering from this frustrating and sometimes dangerous condition. Recovery can begin with a trip to a family doctor.

When Your World Begins to Spin Understanding and coping with dizziness