Roughly 25% of people over 65 say they periodically or frequently experience symptoms of dizziness. One might hope that such a common symptom would be well-understood and readily treatable, but that is far from the case. In fact, contemplating the complexities surrounding this topic is enough to make one dizzy in itself! Let's take a look at just some of the reasons dizziness is so problematic.

What's in a Word?
To begin with, dizziness means very different things to different people. For some it means a sensation of spinning or movement. Others perceive it as unsteadiness and loss of balance. Still others experience dizziness as lightheadedness, giddiness or a sensation of faintness.

Because of these disparities, clinicians tend to place a patient's dizziness into one of four general categories to help in diagnosis. The first is vertigo. Derived from the Latin verb "to turn," vertigo refers to an unreal sensation of moving, turning or spinning. (Vertigo has nothing to with fear of heights, despite the portrayal in the classic Hitchcock thriller of the same name.) Dizziness of the vertigo type is often, but not always, due to a disorder in the inner ear.

The second category of dizziness is disequilibrium, the sensation of being unsteady or off balance when walking. Whereas vertigo may be experienced in any position, disequilibrium occurs only when standing. A wide range of neurological, visual or inner ear causes can contribute to disequilibrium.

The third category is "presyncopal lightheadedness," which refers to the sensation of being about to faint. It is often accompanied by weakness and graying of vision.

Finally, some sensations of dizziness are so hard to describe that they are categorized as "other dizziness." Depression, anxiety, drug side effects, and miscellaneous other causes may be responsible.

Blind Men and the Elephant
When presented with a patient's symptoms, physicians try to reach a diagnosis using various clinical evaluation tools. In the case of dizziness among seniors, this is a daunting challenge. For one thing, physicians disagree widely on the prevalence of different causes. Because they approach the problem from the standpoint of their particular specialty, physicians can be like the fabled blind men examining the elephant, each drawing different conclusions.

Despite this problem, some disorders causing dizziness in seniors are clearly more prevalent than others. Benign paroxysmal positional vertigo (BPPV) is one of the commonest culprits. People with this inner ear disorder experience episodes of vertigo provoked by changes in head position or rolling over in bed. The problem tends to wax and wane in severity. It is due to the migration of tiny calcium particles within the structures of the inner ear. BPPV is often treated with drugs like meclizine (Antivert, Bonine) with varying results. A more definitive treatment is called canalith repositioning, in which a physician puts the patient's head through maneuvers designed to move the offending particles back where they belong.

Another common disorder in seniors is postural hypotension, an example of presyncopal lightheadedness. Patients with this problem experience faintness standing up which is relieved by sitting or lying down. It is caused by a drop in blood pressure, which in turn can be aggravated by medications, neurological disorders, heart disease or other underlying factors. Seniors are more subject to this kind of dizziness due to age-related blunting of the postural reflexes that maintain blood flow to the brain.

A Syndrome of Aging
Although diagnoses like the foregoing can sometimes be reached with confidence and specific treatments prescribed, things aren't so simple for many older dizziness sufferers. Often the cause is unclear and the treatment unsatisfactory. For many seniors dizziness is experienced as multiple sensations; more than one underlying contributor may be present. For this reason, more and more experts think of persistent dizziness among seniors as an age-related syndrome that can be managed but may not always be cured.

Managing dizziness usually involves several strategies. Eliminating offending medications is one example, since many drugs can aggravate dizziness. Avoidance of triggering events-like moving abruptly, tilting the head back or standing suddenly--is also important. When arising from bed, one should sit up momentarily, then stand slowly and steady oneself before starting to walk. Supervised balance exercises or Tai Chi classes are also beneficial for some seniors.

One final caveat, however: even though in some people the cause of dizziness is elusive, in others a serious inner ear, neurological or heart disorder is present. Therefore, the first step should always be to consult one's physician.

January, 2004