• Combating Dizziness in Older Adults

    IMAGE "Dizziness is very common in all adults, but there are special reasons why older people may become dizzy, including the various medicines 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 of dizziness 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 medicines used to lower your hypertension or treat prostate problems—the low blood pressure may make you dizzy when you stand up."

    Many Different Factors

    There are a range of conditions that can cause dizziness. Finding the origin of the sensation is perplexing and frustrating to doctors and their patients. Causes vary from low blood pressure to medicine side effects to neurologic or inner ear problems. Examples of conditions that can increase the risk of include:
    "One of the most common causes of dizziness is known as benign paroxysmal positional vertigo (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 do not belong, they can cause dizziness, sometimes associated with nausea, upon certain movements.
    It is 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 anxious can also precipitate dizziness. Certain neurologic disorders can bring on episodes of dizziness, as well.
    "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 medicines may cause dizziness. Some examples include:
    • Heart medicines (eg, alpha blockers, beta blockers, angiotensin-converting enzyme inhibitors, diuretics, nitrates)
    • Medicines that affect the central nervous system (eg, antipsychotics, opioids, drugs to treat Parkinson's disease, muscle relaxants, tricyclic antidepressants)
    • Erectile dysfunction medicines (eg, sildenafil [Viagra], drugs to relieve cramps in the bladder)
    If you notice that the dizziness is more significant during a specific time of day or after trying a new medicine, it may be that the drug is a key culprit.

    Do Not Suffer in Silence

    Dizziness is not a normal consequence of aging. It is a symptom that the body is not functioning properly. If you are experiencing symptoms, talk to your doctor. A diary chronicling your activities, medicines, and descriptions of dizzy episodes often help doctors narrow the possibilities.
    "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."

    RESOURCES

    American Academy of Family Physicians http://www.aafp.org/

    Vestibular Disorders Association http://www.vestibular.org/

    CANADIAN RESOURCES

    Canadian Medical Association http://www.cma.ca/

    Health Canada http://www.hc-sc.gc.ca/

    References

    Department of Otolaryngology, Cleveland Clinic. Available at: http://www.clevelandclinic.org .

    Dizziness—differential diagnosis. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed/. Updated April 21, 2011. Accessed July 20, 2011.

    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.

    Post R, Dickerson L. Dizziness: a diagnostic approach. American Family Physician website. Available at: http://www.aafp.org/afp/2010/0815/p361.html. Published August 15, 2010. Accessed August 22, 2011.

    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/ .

    Vestibular frequently asked questions. Johns Hopkins University website. Available at: http://www.bme.jhu.edu/labs/chb/faq/faq.html .

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