9īarin and Dodson 2 divided the underlying causes of disequilibrium and dizziness in the elderly into three broadly defined types:įinally, an assortment of environmental and lifestyle factors, which may be responsible for increased frequency of balance disorders and dizziness in older persons. 8 Although most types of dizziness in the elderly are benign, in a few patients however, there underlies a serious and probably life-threatening cause, such as a stroke, which occurs more commonly in older patients. 7 Accordingly, dizziness in the elderly is actually a multifactorial geriatric syndrome manifesting in multiple ways and involving several organic systems, such as sensory, neural and cardiovascular. Vestibular and proprioceptive functions are affected and the impairment of their central integration along with various other sensory inputs that are related to aging, including vision and hearing, constitute the phenomenon of presbyequilibrium, occasionally called multisensory dizziness. 6 The main feature of dizziness in the elderly is the gradual multisensory deterioration of balance. 6Ī specific feature of balance disorders in elderly is that older patients complain less of rotatory vertigo and more often of nonspecific unsteadiness and dizziness than younger persons with a similar disease. 5 Common causes of vertigo in the elderly may manifest differently, with a more confusing set of symptoms, as patients tend to report rotatory vertigo less and nonspecific dizziness and instability more than younger patients with the same condition. 3 Dizziness has increased prevalence in women 4 and is a major factor for disability in persons beyond 65 years of age. 1 The presence of dizziness constitutes a major predictor of falls in the elderly, which are the leading cause of accidental death after the age of 65 years. Vestibular symptoms and dizziness are a usual and significant problem in the elderly, where their prevalence has been estimated to be 30% in persons older than 60 years, 1, 2 and approaching 50% after the age of 85 years. Specific issues which should be considered in the elderly are: 1) difficulty in obtaining an accurate history 2) difficulty in performing the diagnostic and therapeutic maneuvers, which should be executed with slow and gentle movements and extremely cautiously to avoid any vascular or orthopedic complications and 3) the relation between BPPV and falls. However, in older patients, its prevalence is higher and it responds less effectively to treatment, having a tendency for recurrence. BPPV in older patients does not differ significantly from BPPV in younger patients, with regard to pathogenesis, diagnosis and treatment. This review presents current insights into the diagnostic, pathogenetic and therapeutic aspects of BPPV in the elderly. BPPV presents a specific paroxysmal positional nystagmus which can be obtained using the appropriate diagnostic positional test and can be treated effectively using specific therapeutic maneuvers. One third of elderly patients with vertigo were diagnosed with benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness in both primary care specialist Neurology and Ear Nose Throat settings. Balance disorders, unsteadiness, dizziness and vertigo in the elderly are a significant health problem, needing appropriate treatment.
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