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This chapter addresses the following Geriatric Fellowship Curriculum Milestone: #54

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LEARNING OBJECTIVES

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Learning Objectives

  • Understand the epidemiology and pathophysiologic mechanisms that contribute to chronic dizziness in older persons.

  • Describe different presentation types of dizziness.

  • Describe key elements of history and physical examination needed to create a differential diagnosis.

  • Identify and describe the evaluation and management of common causes of dizziness.

  • Discuss the role of vestibular rehabilitation in the management of chronic dizziness.

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Key Clinical Points

  1. Dizziness is associated with increased fear of falling, worsening of depressive symptoms, and functional disability.

  2. Dizziness is often classified in four types: vertigo, dysequilibrium, presyncope, and other nonspecific sensations such as whirling and floating. A fifth category, “mixed dizziness”—combinations of these four types—is the most common type of dizziness reported by older persons.

  3. Chronic dizziness should be considered a geriatric syndrome, as it involves multiple factors or diseases affecting multiple systems.

  4. A careful history and clinical examination are required to evaluate dizziness.

  5. Expensive tests, such as neuroimaging, electronystagmography (ENG), and computerized posturography, are often not needed in the evaluation of dizziness.

  6. Multifactorial interventions can help in either alleviating dizziness or decreasing the disabilities associated with dizziness.

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DEFINITION

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Dizziness is a broad term used to describe various abnormal sensations arising from perceptions of the body’s relationship to space or of unsteadiness. Dizziness has been arbitrarily defined on the basis of duration as acute (present for < 2 months) or chronic (present for > 2 months). The differential diagnosis of acute dizziness is similar in younger and older persons, and management of acute dizziness is not qualitatively different in older persons as compared to younger adults, with the possible exception that recovery may be more prolonged in older adults. This chapter focuses on chronic dizziness.

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EPIDEMIOLOGY

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The prevalence of dizziness ranges from 4% to 30% in persons aged 65 or older, and more commonly is reported by women than men. In one study of persons aged 65 and older, the likelihood of reporting dizziness increased by 10% for every 5 years of increasing age.

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Chronic dizziness is associated with a number of comorbid conditions, including falls, functional disability, orthostatic hypotension, syncope, and strokes. In older persons, chronic dizziness can cause substantial adverse effects on a person’s quality of life. In one prospective study of older persons with dizziness, after 2 years of follow-up, older persons with dizziness were more likely to become disabled than were those who were not, although mortality was no different. In another study, 197 older persons with chronic dizziness reported poor health-related quality of life, most notably in relation to limitations in the physical and emotional dimensions. Chronic dizziness is also associated with fear of falling, worsening depressive symptoms and self-rated health, and decreased participation in social activities.

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PATHOPHYSIOLOGY

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Dizziness is a sensation of postural instability or imbalance. Causes of dizziness can be difficult ...

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