Dizziness or lightheadedness when standing occurs in about 15 to 20 percent of older adults. It is more common in people with comorbidities, especially high blood pressure, and in people living in long-term care facilities. Many falls can be caused by dizziness when standing. Older adults should avoid standing for long periods of time.
The increased incidence in older adults is due to decreased responsiveness of blood pressure-regulating receptors combined with increased stiffness of the artery walls, which makes it harder for the arteries to move more blood to increase blood pressure. Decreased receptor responsiveness slows the normal response of the heart and blood vessels to standing. Paradoxically, high blood pressure, which is more common in older adults, may contribute to decreased receptor sensitivity, increasing the risk of dizziness when standing.
In some people, especially older adults, blood pressure drops too much when they sit or stand (a condition called orthostatic hypotension or postural hypotension). Symptoms of fainting, lightheadedness, dizziness, confusion, or blurred vision occur within seconds to minutes of standing (especially after lying in bed or sitting for a long time) and quickly go away when the person lies down. However, some people fall, faint, or very rarely have a brief seizure. Symptoms are more common and worse after people exercise, drink alcohol, and/or eat a large meal, or are dehydrated.
What causes dizziness when standing up?
Dizziness or lightheadedness when standing up occurs due to abnormal blood pressure regulation. Normally, when people stand, gravity causes blood to pool in the veins in the legs and torso. This pooling reduces blood pressure and the amount of blood the heart pumps to the brain. Low blood flow to the brain causes dizziness and other symptoms. To compensate, the nervous system rapidly increases the heart rate and constricts blood vessels, helping blood pressure return to normal quickly before symptoms can develop. The part of the nervous system responsible for this compensation is the autonomic nervous system.
Many disorders can cause problems with blood pressure regulation and lead to dizziness when standing up.
The most common causes of new dizziness when standing up include:
- Low blood volume (possibly due to dehydration or blood loss)
- Medications
- Prolonged bed rest
- Underactive adrenal glands (adrenal insufficiency)
- The most common causes of dizziness when standing up that have been present for a long time (chronic) include
- Age-related changes in blood pressure regulation
- Medications
- Autonomic nervous system problems
What are the treatments for dizziness when standing up in older adults?
- Any cause can be treated when possible, including changing or stopping any medications that are causing the condition. However, many causes cannot be cured and people must take steps to reduce their symptoms.
- People who are bedridden for long periods of time should sit up every day and exercise in bed when possible. People who are lying down or sitting should stand up slowly and carefully.
- Staying hydrated, limiting or avoiding alcohol, and exercising regularly when possible are all helpful.
- Regular moderate exercise increases muscle tone in the walls of your blood vessels, which helps reduce pooling of blood in your legs.
- Sleeping with the head of your bed raised may help relieve symptoms.
- For some people, increasing salt intake can increase fluid retention and relieve symptoms. Your doctor may recommend increasing your salt intake by adding salt to your food or taking sodium chloride tablets. However, increasing salt intake may not be recommended for people with heart disease.
Medication may be used, but it is important to see your doctor to find out the exact cause and get the most appropriate medication to help minimize the risks of taking it.
