Definition and Overview
Age-related dizziness and imbalance is a multifactorial dizziness and balance disorder that commonly occurs in people over 60 years of age due to complex decline in the functions of the vestibular system, visual system, and proprioceptive system and decreased autonomic response due to aging.
Approximately 30% of adults over 65 years of age complain of dizziness, which is one of the main causes of falls. In the elderly, dizziness is often caused by a combination of factors rather than a single cause, so a comprehensive evaluation and personalized treatment plan are necessary.
Causes and Pathophysiology
decreased vestibular function
The number of vestibular hair cells in the inner ear decreases with age, and the number of vestibular nerve fibers also significantly decreases after the age of 60. Aging of the cerebellum and vestibular cortex also reduces central balance processing ability.
Deterioration of visual system function
Age-related decline in visual function, such as cataracts, macular degeneration, visual field narrowing, and decreased contrast sensitivity, reduces the accuracy of visual balance information.
Proprioception and musculoskeletal changes
Decreased peripheral nerve conduction velocity, decreased vibration and position sense, and decreased muscle strength (sarcopenia) reduce the ability to maintain position.
Deterioration of autonomic function
The frequency of orthostatic hypotension in people over 65 years of age is approximately 20%. When standing, the blood pressure control response slows down and the heart rate response decreases, resulting in decreased cerebral perfusion.
Polypharmacy
Antihypertensive drugs, diuretics, sedative-hypnotics, antihistamines, and antidepressants cause or worsen dizziness by lowering blood pressure, suppressing vestibule, and decreasing cognitive function. The risk of dizziness and falls is significantly increased in older adults who take five or more medications.
symptoms
The main symptoms of geriatric dizziness are often lightheadedness, disequilibrium, and balance disorders compared to vertigo.
Main symptoms: - Feeling of instability when walking or changing posture - Feeling dizzy or fainting when standing up - Difficulty maintaining balance in the dark - Uncertain steps, reduced stride length - Restriction of activities due to fear of falling (fear of falling)
In cases accompanied by otolithiasis (BPPV), rotational dizziness appears for several seconds when changing certain head positions.
diagnosis
comprehensive evaluation
In the history taking, the nature of the dizziness (rotational/non-rotational), the circumstances in which it occurs (standing/walking/change of head position), accompanying symptoms, and the list of medications taken are identified in detail.
Differential diagnosis
First rule out correctable causes: - Benign paroxysmal positional vertigo (BPPV): confirmed by Dix-Hallpike test - Orthostatic hypotension: Measurement of blood pressure and pulse before and after standing. - Drug-induced dizziness: review medications taken - Central dizziness: signs of neurological abnormalities, brain imaging tests
Fall risk assessment
Simple gait speed, Timed Up and Go (TUG), and Berg balance scale are used to assess fall risk.
autonomic nerve test
Deterioration of autonomic function is checked by measuring heart rate variability (HRV) and blood pressure changes before and after standing.
treatment
Customized treatment by cause
If BPPV is confirmed, the Epley maneuver is the first-line treatment. For orthostatic hypotension, water and salt supplementation, compression stockings, and correction of standing behavior are performed.
De-prescribing
Review medications that may cause dizziness and reduce them to the lowest effective dose or discontinue them. Medication management must be done in consultation with a specialist, and clinical studies have confirmed the effect of reducing the risk of falls through polypharmacy adjustment.
Vestibular Rehabilitation and Balance Exercises
Vestibular rehabilitation therapy reduces the risk of geriatric dizziness and falls by strengthening balance compensation mechanisms. Tai chi, balance board training, and walking training are representative exercise programs.
Environmental Modification and Falls Prevention
It is important to create an environment to prevent falls, such as removing obstacles in the home, ensuring adequate lighting, installing bathroom handles, and using anti-slip mats. Choosing the right shoes also helps maintain balance.
Cognitive and Psychological Support
Fear of falling leads to a vicious cycle of activity avoidance and functional decline. When necessary, cognitive behavioral therapy (CBT) or graded activity exposure can be helpful.
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This information is provided for medical educational purposes and is not a substitute for individual medical care or treatment. If you have any symptoms, be sure to seek professional advice. Inquiries: Osang Neurosurgery 1599-5453 | osns.co.kr