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Dizziness in the elderly

Abstract Dizziness is largely a problem in the elderly, being the most common reason patients over the age of 75 years seek medical attention. The term is used to describe many sensations, including vertigo, disequilibrium and light-headedness. There are different causes of dizziness in older people such as cardiovascular, neurological or locomotor disease, deterioration in sensory organs, vestibular dysfunction and adverse drug effects. Distinctions between the effects of aging and borderline pathology on instability and falls are not always clear-cut. The elderly's greater risk of balance disorders stems from a higher likelihood of impairments or diseases affecting the physiological subsystems underlying the complex skill of balancing. Diagnosing a specific cause of dizziness or vertigo in older people can be a challenge, since the symptom descriptions are often vague and examination findings overlap among potential causes. Once a differential diagnosis is formulated, it is not clear what tests – if any – will add clinical value. Intervention needs to be tailored to each patient to obtain the maximum effect, designing different exercises for individuals with different kinds of deficiency. Vestibular dysfunction in the elderly can be treated effectively with vestibular rehabilitation, which comprises both a ‘generic’ type and more specific protocols. Moreover, all the following interventions may have a role: exercises designed specifically to improve muscle function and to address sarcopenia, visual deficit treatment, pacemakers, vitamin D supplementation, gradual withdrawal of psychotropic medication, multifaceted podiatry and hip protectors, cognitive behavioural interventions, home safety assessment and modification interventions. In many cases, a multifactorial approach could be the best solution, as the elderly are frequently affected by multiple deficiencies. There is strong scientific evidence that rehabilitation has a significant role for multisensory dizziness, vestibular hypofunction and locomotor pathologies. More research is needed to evaluate the benefit of rehabilitation for neurological causes and benign positional paroxysmal vertigo.