Dizziness usually includes a feeling of restlessness and discomfort in the body. These feelings include lightheadedness, drowsiness, fatigue, and weakness.
Based on the symptoms, dizziness can be of four types. They are:
- Vertigo: Dizziness is a feeling of the head spinning without any movement.
- Loss of balance: In this condition, the patient cannot maintain balance. The patient is often unable to walk normally.
- Fainting: This is a feeling that lasts only for a minute or a few minutes. Usually, the symptoms are similar to the complications that appear before fainting. Patients often complain of loss of vision, excessive sweating, and loss of balance.
- Dizziness: This is a feeling similar to the feeling of sudden fainting.
What are the causes of dizziness in the elderly?
Dizziness is common in older people, with nearly 30 percent of people over 65 experiencing it. The incidence is even higher in people in their eighties (50 percent of people over 85 experience dizziness).
The main causes include:
1. Blood pressure
Aging is associated with changes in the cardiovascular system. With increasing age, blood vessels lose their elasticity. Such changes are accompanied by thickening of the arterial walls and collagen deposition in the middle layer of the blood vessels. This is one of the main reasons why blood pressure increases with age. Nearly 50 percent of the world’s population over 65 suffers from hypertension.
In addition, in some cases, blood pressure can suddenly increase or decrease. Such incidents often occur after meals or dinner. This is related to the dilation of blood vessels due to increased levels of vasoactive gastrointestinal peptides or insulin. Sudden changes in posture are also a cause of sudden drops in blood pressure. These conditions are associated with abnormal heart rhythms or impaired baroreflex sensitivity (a response that controls heart rate). Such conditions are called orthostatic hypotension. These changes in blood pressure levels are associated with changes in blood supply and a feeling of dizziness.
2. Heart disease
The incidence of cardiovascular disease in the elderly is very high. Such pathological changes are manifested by anatomical and functional changes in the heart. Such changes are classified according to the observed changes in cardiac output and cardiac index. The cardiac output of an 80-year-old person is almost half that of a young person. Increasing age causes a decrease in the function of the myocardium. Senile pulmonary fibrosis is also an important age-related change in the heart. In addition, aging causes amyloid deposition in various parts of the heart. Increased afterload on the heart is associated with changes in the shape of the heart. In addition, heart valve diseases are also common in the elderly.
3. Neurological disorders
Neurological diseases and neurodegenerative changes seen in the elderly can cause dizziness. In the elderly, degenerative changes in nerve cells lead to decreased conduction velocity of nerve impulses and fluctuations in neurotransmitter concentrations. In addition, the decline in gray and white matter in the brain leads to impaired brain function. In addition, age-related brain changes due to lack of blood supply are also causes of dizziness. Such changes are seen in people who have had a stroke, causing lack of blood supply in the posterior fossa of the brain and cerebellum. Neurological disorders such as Parkinson’s disease, Alzheimer’s disease, and multiple sclerosis are also causes of such conditions. The death of nerve cells and changes in neurotransmitter levels are associated with such changes. Migraines, which are associated with the dilation of blood vessels in the brain and activation of trigeminovascular neurons, can also cause dizziness.
4. Peripheral vestibular disorders
These conditions cause a disruption of the body’s balance mechanism. Several conditions are associated with such disorders. Benign paroxysmal positional vertigo (BPPV) is a disorder of the inner ear and is one of the common causes of dizziness. It is caused by mineral crystals getting stuck in the ear canal. In addition, fluid buildup in the inner ear can cause such complications. Such conditions are called Ménière’s disease.
How to diagnose dizziness in the elderly?
Diagnosis of dizziness is done by carefully taking a medical history. Patients often complain of weakness and fatigue. They often lose their balance and cannot walk or talk normally. In some cases, there is sudden darkness or loss of vision, loss of sensation.
Diagnostic tests that help diagnose such conditions are:
1. Pulse and heart rate
The patient’s pulse and heart rate are checked. An electrocardiogram is useful to detect any changes in the heart. In addition, fluctuations in the heart rate are assessed in both the upright and supine positions.
2. Nystagmus
Nystagmus or rapid eye movements can be useful in distinguishing between central and peripheral causes of dizziness. In peripheral dizziness, the nystagmus usually moves horizontally and in one direction, with the rapid phase moving away from the affected area. Nystagmus can be suppressed by visual fixation. Tinnitus and hearing loss may also occur. Central vertigo, on the other hand, can result in nystagmus that moves in any direction. Vertical or purely torsional nystagmus is usually associated with central problems, often accompanied by focal neurological symptoms.
3. Neurological examination
Neurological examination is useful in assessing the function of the cranial nerves.
4. Physical examination
A physical assessment of the patient is important. Assessment of the patient’s gait and a hearing test are necessary in such cases.
5. Provocation test
This test is also known as the Dixie-Hallpike maneuver. This test is performed to detect benign paroxysmal positional vertigo (BPPV).
