When the Room Won't Stop Spinning: Combatting Dizziness in Older Adults

For dozens of reasons, dizziness affects millions of older adults.

"Dizziness is very common in all adults, but there are special reasons why older people may become dizzy, including the various medications they take," says David A. Drachman, MD, professor and chairman of the Department of Neurology at the University of Massachusetts Medical School in Worcester, Massachusetts.

In a paper published in the Journal of the American Medical Association in April 2000, Yale University researchers reported that approximately one-quarter of older adults had experienced at least one episode of dizziness within the previous two months. And a 1995 Swedish study found that one-third of its 76-year-old participants suffered from dizziness severe enough to put a crimp in their quality of life. The sensation can be disabling and is an increased risk factor for falls, both of which can rob older adults of their independence.

Why and How It Happens

"Older people may develop medical conditions, such as diabetes, which can cause multisensory dizziness," Drachman says. "We all need accurate vision, hearing, inner ear function and peripheral nerve sensation to reliably assess where we are and how we are moving. If you lose more than one of those sensors, then you may experience dizziness."

Dizziness occurs when the brain receives inadequate or conflicting messages from these sensors about the body's position or motion in space. According to Drachman, "Older people are especially vulnerable, because there are more things that can interact to produce conditions leading to dizziness. For example, excessively low blood pressure may result from medications used to lower your hypertension or treat your prostate problemsthe low blood pressure may make you dizzy when you stand up." Many Different Factors More than 60 conditions can cause dizziness. Finding the origin of the sensation is perplexing and frustrating to medical professionals and their patients. Causes vary from low blood pressure to medication side effects to neurologic or inner ear problems. A prior heart attack, arthritis, diabetes, alcohol consumption, smoking, nervousness, and other conditions can add to the risk. "One of the most common causes of dizziness is known as benign paroxysmal positional vertigo, or BPPV," Drachman says. "This is a sensation of actually spinning around, which may occur when you lie down, sit up or roll over in bed. This rotational sensation is known as 'true vertigo' and occurs when tiny calcium crystals in one part of the inner ear break loose and drift into one of the semicircular canals in another part of the ear." As the loose crystals move back and forth where they don't belong, they can cause violent dizziness, sometimes associated with nausea, upon certain movements.
It's important to note that there is a difference between vertigo and dizziness. Vertigo refers to a sensation of motion when you are resting; dizziness denotes less specific symptoms, such as lack of balance and lightheadedness. This subtle difference can be an important factor in diagnosing the problem. Another reason for dizziness can be attributed to the circulatory system, which supplies the brain and inner ear with blood and oxygen. Insufficient circulation, due to hardening of the arteries, decreased blood pressure, or poor heart function, can all result in dizziness. A drop in blood pressure when first standing up, a condition called "postural hypotension," triggers many episodes of dizziness. Feeling upset or anxious can also precipitate dizziness. Certain neurologic disorders can also bring on episodes of dizziness. "Transient ischemic attacks, known as 'ministrokes', can produce vertigo, which is almost always associated with other symptoms such as numbness or weakness of an arm or leg," Drachman says. "Following head injuries, people may experience lightheadedness, and sometimes vertigo if the inner ear is affected. In younger people, multiple sclerosis can be a cause of dizziness." Many medicationsincluding Dilantin, Lasix, L-dopa, and even Tagametmay cause dizziness. If you notice that the dizziness is more significant during a specific time of day or after trying a new medication, it may be that the drug is a key culprit.
Don't Suffer in Silence Dizziness is not a normal consequence of aging. It's a symptom that the body is not functioning properly. While usually not indicative of a serious condition, it can be a sign of an impending stroke or an irregular heart rhythm. "While many people get dizzy and many causes are benign, some are not," Drachman concludes. "Always seek medical care if you feel as if your world is unstable." If you are experiencing symptoms, talk to your doctor or request a referral to a specialist. A diary chronicling your activities, medications, and descriptions of dizzy episodes often help doctors narrow the possibilities. Diagnosing and Treating the Problem A complete physical exam and various tests can help determine a reason for the uncomfortable sensations. While dizziness accounts for 10 million office visits every year (and $1 billion/per year!), many physicians have difficulty uncovering the cause. "A thorough neurologic and hearing exam is very important. And certain laboratory studies are often needed. The problem is that most doctors are uncomfortable dealing with the detailed diagnosis of dizziness," Drachman says. "There are a limited number of physicians who have the expertise to take on all of the problems that may cause dizziness, ranging from agoraphobia to strokes, or vestibular disorders, drops in blood pressure or cardiac arrhythmias. The problem of dizziness crosses many specialties."
As a result, it can be very difficult to manage and treat. Treating any underlying medical condition leads the list of interventions. Benign paroxysmal positional vertigo can be cured in a few minutes without medications or surgery. A physician who is confident of the diagnosis and experienced in the treatment, can use a set of exercises and literally roll the loose crystals back where they came from, eliminating the dizziness completely. Even if the symptoms disappear, however, they will recur about 30% of the time. For others, a change in medications may be required. The doctor may order additional drugs or physical therapy. Patients can learn exercises that improve balance and techniques to decrease symptoms. Treatment may proceed in stages, as problems resolve. "We estimate that 80% or more may get either some or great relief," Drachman says. Taking Care of Yourself In addition to seeking medical advice, changing a few habits can make a difference in your symptoms: Stand up slowly. First thing in the morning, sit briefly on the edge of the bed before getting up.Change positions gradually. Avoid sudden turns or extreme head movements.Keep the lights on, use a night-light and always turn the lights on before entering a room.Use a walker or cane, if recommended by your doctor.Wear a hearing aid, if you have trouble hearing.Do not wear bifocals when walking outdoors.Improve balance and strength by following a home-exercise program, if approved by your physician.Take medications as prescribedDecrease caffeine and salt intake, which can affect circulation.Avoid alcoholic beverages.Manage stressful situations, possibly learn relaxation techniques.Do not drive, climb a ladder or participate in other potentially dangerous activities when you feel dizzy.
If you feel a vertigo attack coming on: Lie down on a firm surface in a darkened room.Stay as still as possible.Keep your eyes open. It may help to stare at a stationary object.Take any medications that you have for an attack.Don't get up until the spinning passes. When you do get up, do so slowly.Find a comfortable place to rest or sleep for several hours while you regain your sense of balance. RESOURCES: Department of OtolaryngologyCleveland Clinic http://www.clevelandclinic.org NeurologyUniversity of California, Los Angeles http://www.neurology.ucla.edu/neurotol.htm CANADIAN RESOURCES: Hotchkiss Brain Institute http://www.hbi.ucalgary.ca/index.php Canadian Society of Otolaryngology http://www.entcanada.org/public.asp References: Department of Otolaryngology, Cleveland Clinic. Available at: http://www.clevelandclinic.org. Dizziness and motion sickness. American Academy of Otolaryngology website. Available at: http://www.sinuscarecenter.com/dizzyaao.html. Drachman D. A 69-year-old man with chronic dizziness. JAMA. 1998; 280:2111-18.
Grimby A, et al. Health-related quality of life and dizziness in old age. Gerontology. 1995;41: 286-98. Tinetti ME, et al. Dizziness among older adults: a possible geriatric syndrome. Ann Intern Med. 2000;132:337-34. University of California, Los Angeles, Neurology. Available at: http://www.neurology.ucla.edu/neurotol.htm. Vestibular frequently asked questions. Johns Hopkins University website. Available at: http://www.bme.jhu.edu/labs/chb/faq/faq.html. Last reviewed February 2008 by Jill D. Landis, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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