Causes of Dizziness in Older Adults

Dizziness symptoms are one of the  most common complaints among elderly people, with about 25% of people over the age of 72 reporting that they experience imbalance or unsteadiness. Age-related degeneration of the inner ears and neck are key causes of dizziness in older people (1). Unfortunately, the increased risk for dizziness coincides with reduced function of the balance and postural muscles, so older people who have dizziness symptoms are more likely to fall than a younger person. Since falls are the number one cause of hospital admissions and accidental death in older adults, it is important that they address symptoms of dizziness right away.

Dizziness is a  term that can encompass lightheadedness, wooziness, vertigo (spinning), fear,  and imbalance. If you are experiencing spells of dizziness, try to describe the sensation(s) to your healthcare provider carefully so that they can make an accurate diagnosis.

The Vestibular System

Throughout life, we rely on the vestibular system, located in the inner ear, to help  keep our balance. The vestibular system is a part of the nervous system that is responsible for telling the brain about our balance. Every time you move, your vestibular system relays information about your speed, direction, and overall posture to your brain so it can coordinate your next movements and keep you moving safely in the direction you want to go. If the vestibular system is impaired, your balance will suffer, and you will experience dizziness symptoms.

Most of us only think about our ears in terms of hearing, but they actually play a significant role in maintaining posture and balance. The ear has three parts:

• The outer ear, which includes the ear lobe, canal and eardrum.
• The middle ear, which contains the bones of hearing and the pressure-controlling Eustachian tube
• The inner ear, which includes the cochlea and the labyrinth of the vestibular system

The labyrinth of the inner ear, or vestibular system,  is responsible for controling eye movement, holding the head steady, sensing our body position,  and then relays this information to the   brain. There are two important balance detectors in the inner ear:

• Semicircular canals: There are three fluid-filled semicircular canals in each inner ear that are responsible for providing rotational information to the brain. The semicircular canals tell the brain to hold the eyes steady whenwe are nodding or turning our head, to keep the head straight on our shoulders, and to control balance when we are getting out of bed, walking in the home or community, or exercising and doing more complex activities.  Dysfunction in the semicircular canals often causes vertigo, which is experienced as a spinning sensation even when you are not moving.
• Otolithic organs: Each inner ear has a set of otolithic organs, called the utricle and saccule, that provides information about our linear movement (forward/backward, up/down, left/right). The otolith organs are covered by a gelatinous membrane that has heavy calcium carbonate crystals embedded in it that act as ballast stones. When you move your head, the crystals bend hair cells that are attached to otolith organs that send information to the brain about linear movements. If these crystals become detached from the membrane, they can float freely and cause a disruption of function in the semicircular canals of the inner ears. . This can lead to the sensation of vertigo and cause dysequilibrium and even falls in older patients.

The balance centers in the brain receives information from the vestibular system and integrates it with other sensory information (vision, touch) to control balance. For example, when you are walking, your vestibular system  (semicircular canals and otolith organs) sends information to your brain about your orientation and movement. Your brain is also receiving information about what you see and whether the ground you’re walking on is flat and stable. All of these pieces of information help the brain decide the safest way to proceed when performing different activities, such as getting out of bed and walking in the local grocery store

While dizziness and imbalance can stem from dysfunction in the balance centers in the brain, the peripheral vestibular system and the neck (cervical spine) account for the majority of cases of unexplained dizziness. When the vestibular system is working normaly, it tells your brain where you are with respect to gravity – it is like a gyroscope.  Also, when the neck is healthy, it allows natural movement of the head to allow the gyroscopes to sense movement easily.  If one or both of these systems breaks down, it leads to disorientation and the dizziness symptoms the older patient may feel.

What are the primary causes of dizziness symptoms in older adults? 

The most common cause of dizziness in the elderly is benign paroxysmal positional vertigo (BPPV). BPPV is caused when the calcium carbonate crystals in the otolithic organs of the inner ear are dislodged from the gelatinous membrane that normally holds them in place. When these crystals become free floating, they can erroneously activate the hair cells in the semicircular canal, resulting in a brief, and often intense sensation of vertigo when you change position of the head or body.

Many people with BPPV experience the symptom of vertigo when they move their head up or down or when rolling over when they’re lying down in bed. The dizziness usually resolves within 15-20 seconds, as the crystals settle at the base of the semicircular canal.. BPPV may also cause nausea/vomiting, nystagmus (rapid, involuntary eye movements), feeling lightheaded, and a feeling of fainting.

The second most common cause of dizziness in older adults is a progressive degeneration of the spine, particularly the cervical spine or neck.  When your neck becomes degenerated due to the natural course of aging and/or due to arthritis, it does not move as easily and can send error messages to the brain about the position of the head.  When there is a sensory mismatch between what your neck sensors are say and what your vision and vestibular system are saying, the consequence is dizziness symptoms, in particular, imbalance that can lead to falling.

Abnormal regulation of blood pressure is common among the elderly. Orthostatic (or postural) hypotension is caused by low blood pressure, and dizziness is a key symptom. If you’ve ever stood up too quickly and experienced wooziness or lightheadedness, you’ve experienced orthostatic hypotension. These dizziness spells are usually over within a few seconds.

Anxiety and other mental health disorders can cause dizziness. This is especially relevant to elderly people, because if they are anxious about losing their balance, they may increase their risk for becoming dizzy and falling.

Finally, many medications are known to cause dizziness as a side effect. ACE inhibitors, beta-blockers, and calcium-channel blockers are common blood pressure medications that are prescribed to elderly patients. In addition, if you take multiple medications, check with your doctor to make sure that there are no drug interactions that could be making you dizzy.

What helps with dizziness in older adults?

It may not be possible to completely avoid all cases of dizziness, but there are some techniques to reduce or avoid dizziness in elderly people, including:

• Do not suddenly change your head or body position. For example, rather than getting out of bed immediately, sit on the bed for a minute or two before standing.
• When you stand up, make sure you have something you can lean on.
• Dehydration can cause dizziness, so make sure you drink plenty of water.

People who are experiencing dizziness should find a safe place to stand, sit, or if necessary, lie down immediately and stay still until the spell passes. It is recommended that anyone who has fallen as a result of dizziness see their doctor to rule out head injuries or other trauma.

Treating dizziness in older adults

Although dizziness treatment may vary somewhat depending on the cause, there is one treatment option that has consistently been shown to significantly reduce or even eliminate dizziness spells: Vestibular rehabilitation therapy (VRT) or Balance Retraining Physical Therapy (BRPT). VRT/BRPT is an evidence-based strategy that uses physical therapy to reduce symptoms of dizziness and improve balance and posture. The result is improved overall function, independence, and a reduced risk of falling.

The most common cause of dizziness in elderly people, BPPV, responds very well to VRT/BRPT. Providers will perform specific and skilled repositioning maneuvers that move the loose inner ear crystals back to where they came from, the otolith organ, which prevents them from activating the semicircular canals of the inner ear inappropriately.

VRT/BPRT can also significantly help patients with cervical pain, stiffness, and dizziness along with restricted mobility in the spine that creates dizziness symptoms, particularly imbalance.  The use of manual therapy techniques, mobilization of the joints, and the use of modalities like laser light, dry needling (in some states), electricity, and ultrasound, can improve the mobility of the neck and spine, helping to resolve dizziness symptoms.

If you are interested in learning more about VRT/BRPT, contact the experts at FYZICAL Therapy & Balance Centers. Our providers are trained in VRT/BRPT and will develop a custom treatment plan to help you successfully manage your dizziness symptoms.

Can medications improve dizziness in the older adult?

In most cases, there are no medications that can reduce dizziness severity or frequency when these symptoms are associated with the vestibular system or cervical spine. However, medications can be used to help with the nausea that occurs during a spell and with pain and muscle spasms in the neck and spine.

Gender differences in dizziness among the older adults

Throughout life, women have a higher risk for experiencing dizziness symptoms than men, and the older adult is no exception. There are several potential reasons for the gender discrepancy, including increased prevalence of anxiety and other mental health disorders in women. Many people with anxiety disorders report that they experience dizziness symptoms like vertigo or unsteadiness during an anxiety attack.

Another reason for a higher incidence of dizziness symptoms in women is the fact that they more frequently experience migraines. Vestibular migraine is a type of migraine that is associated with symptoms of dizziness, and the spells may occur even without a headache. The cause of vestibular migraine is poorly understood, and the treatment is often medications, which have fair outcomes. VRT has been shown to reduce dizziness related to vestibular migraines.

Dizziness and nausea

Nausea is a common symptom of dizziness. BPPV, the most common form of dizziness, often is associated with nausea/vomiting. In addition, vestibular migraine frequently causes dizziness symptoms of nausea.

Other potential causes for symptoms of nausea with dizziness include low blood sugar, diabetes, food poisoning, stomach viruses and infections, liver dysfunction, stroke, and neurological problems. In addition, prescription drug interactions, alcohol, and recreational drugs may cause dizziness and nausea.

Motion sickness is another description of nausea that comes with dizziness symptoms. Older adults may be at higher risk for experiencing motion sickness due the degeneration of the otolith organs, causing BPPVn. It is important for elderly people to be cautious when bending over and cleaning or reaching down to pick up objects from the floor if they recently became prone to BPPV and motion sickness.

If you are experiencing nausea, you should consult with your physician about possible medications that reduce nausea (an antiemetic). VRT/BRPT can also assist in reducing nausea and motion sickness – speak to your physician or medical provider about a referral for physical therapy. 

The providers at FYZICAL Therapy & Balance Centers use evidence-based physical therapy techniques to help you manage dizziness symptoms and overcome your dysfunction. Using a medication-free and surgery-free approach, our experts develop customized therapeutic exercises that can help you resolve your dizziness symptoms , and get your life back – or as we say – Love Your Life Remember, it is “Your Health, Your Choice” when it comes to choosing your physical therapy provider – we hope you choose FYZICAL.

FYZICAL offers free assessments that can help you understand why you’re feeling dizzy and help you explore ways to resolve these symptoms and regain your life. Find a FYZICAL location near you and make an appointment today.

To learn more about how FYZICAL Therapy & Balance Centers can help you, download our free e-book.

1. Colledge NR, Barr-Hamilton RM, Lewis SJ, Sellar RJ, Wilson JA: Evaluation of investigations to diagnose the cause of dizziness in elderly people: A community based controlled study. Br Med J 1996, 313(28 Sept):788–793.