Dizziness in the elderly

Introduction and epidemiology. Dizziness is a common problem in the community [1], especially in elderly patients [2]. In emergency department (ED) studies, dizziness is one of the most common presenting symptoms [3,4], and misdiagnosis is common, even when patients are evaluated by neurologists [5]. Dizziness has numerous causes and the very word “dizziness” means different things to different people. Older dizzy patients have a higher incidence of serious central nervous system (CNS) and cardiovascular causes [6–8]. Furthermore, dizziness is often caused by a variety of non-CNS or cardiovascular symptoms such as toxic-metabolic and infectious disorders. For all these reasons, correct diagnosis is critically important, but can be challenging. The evidence base for our understanding of the diagnosis and treatment of dizziness is weak [9], but has increased substantially in the past several years [10,11]. Some challenges are unique to the elderly. Age-related changes in cardiovascular and vestibular physiology can alter the presentations compared with younger patients. Secondly, the elderly are more likely to be cognitively impaired, which, even when minimal, can adversely affect their ability to provide a cogent history, which is so important in the evaluation of the dizzy patient. As well, older patients are far more likely to take multiple medications, which can cause dizziness or exacerbate dizziness due to another cause. Fourthly, they are more likely to have comorbidities such as cardiac disease and vascular risk factors, expanding the differential diagnosis and increasing the likelihood of cardiovascular and cerebrovascular causes. Finally, even if the etiology of dizziness is benign, resultant falls, hip fractures, and loss of independence have a greater impact in the elderly.