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 less than 1 or 2 months) or chronic (present for more than 1 or 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 maybe more prolonged in older adults. This chapter focuses on chronic dizziness.
The prevalence of dizziness ranges from 4% to 30% in persons aged 65 years or older, and more commonly is reported by women than men. In one study of persons aged 65 years and older, the likelihood of reporting dizziness increased by 10% for every 5 years of increasing age.
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 significant 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.
Dizziness is a sensation of postural instability or imbalance. Dizziness can be difficult to diagnose, specifically in older persons, in whom it often represents dysfunction in more than one body system. Maintenance of balance and equilibrium is complex, achieved by integration of sensory information obtained from vestibular, proprioceptive, visual, and auditory systems by the cerebral cortex and cerebellum, leading to appropriate balance-maintaining responses. Abnormal function in any one or a combination of these systems may result in imbalance and the sensation of dizziness.
The vestibular system maintains spatial orientation at rest and during acceleration. Elements of the vestibular system and its connecting pathways include the semicircular canals, utricle, saccule, vestibular nerve, vestibular nuclei, vestibulospinal tracts, and vestibulocerebellar pathways. Diseases affecting this system and producing dizziness include Ménière's disease, benign paroxysmal positional vertigo (BPPV), recurrent vestibulopathy, labyrinthitis/vestibular neuronitis, acoustic neuroma, and drug toxicity (especially aminoglycosides). Age-related changes have also been reported in the sensory (hair) cells in the semicircular canals, saccule, and utricle.
The proprioceptive system consists of mechanoreceptors in the joints, peripheral nerves, and posterior columns, and multiple central nervous system (CNS) connections. Proprioception contributes to equilibrium by providing information about changes in body position, and helping mediate the body's response to position change. Common disorders include peripheral neuropathy associated with diseases such ...