Dizziness in the Elderly: A Common Problem

Introduction:

Physical, mental, and psychological well-being are necessary for a healthy lifestyle. An uneasiness is suggestive of the presence of a pathological condition in the body. Elderly people often complain of different complications and uneasiness in the body. These include complications like dizziness, breathlessness, burning sensation in the chest, chest pain, and chronic pain. Needless to say, such complications are caused by several age-related changes in the body. Also, such age-related changes often lead to various pathological conditions in the body.

What Is Dizziness?

Dizziness often encompasses uneasiness and unpleasant sensations in the body. These sensations include lightheadedness, drowsiness, fatigue, and weakness. Based on symptoms, dizziness can be of four types. These are;

1. Vertigo: Vertigo is characterized by a sensation of spinning of the head without any movement.

2. Disequilibrium: In this condition, the person is unable to keep his balance. Persons are often unable to walk properly.

3. (Pre) Syncope: This is a sensation that just persists for a minute or a few. Usually, symptoms are similar to the complications that are seen before fainting. Patients usually complain of sensations of visual blackout, excessive sweating, and loss of balance.

4. Lightheadedness: It is a sensation similar to the sudden feeling of fainting.

What Are the Causes of Dizziness in Elderly?

Dizziness is a common complication seen in elderly people. Almost 30 percent of elderly people above the age of 65 suffer from this condition. The prevalence is even higher in persons who are in their eighties. Fifty percent of the elderly people above the age of 85 suffer from dizziness. The causative factors are;

1. Blood Pressure: Aging is associated with changes in the cardiovascular system. Increased age is responsible for the loss of elasticity of the blood vessels. Such changes are accompanied by thickening of the walls of arteries and deposition of collagen in the middle layer of the blood vessels. This is one of the main reasons for increased blood pressure with increasing age. Almost 50 percent of the world's population above the age of 65 suffer from hypertension. Also, in elderly people, a sudden increase in blood pressure is observed. Also, in some cases, a sudden drop in blood pressure is observed. Such incidents are common after a meal or dinner. This is associated with the dilatation of blood vessels due to an increased concentration of vasoactive gastrointestinal peptides or insulin. A sudden change in the posture is also responsible for a sudden drop in the blood pressure level. These conditions are linked to defective heart rate or defective baroreflex sensitivity (a response that controls the heart rate). Such conditions are known as orthostatic hypotension. These changes in the blood pressure level are associated with an alteration in the blood supply and a feeling of dizziness.

2. Cardiac Diseases: The incidence of cardiovascular diseases among elderly people is very high. Such pathological changes are manifested by anatomic and functional changes in the heart. Such changes are categorized by a change in cardiac output, and cardiac index is observed. The cardiac output of an 80-year-old person is almost half that of a young person. Increased age causes decreased functionality of the cardiac muscles. Fibrosis of the lungs due to aging is also an important age-related cardiac change. Apart from this, aging causes amyloid deposition in the various portions of the heart. Increased afterload in the heart is associated with shape changes in the heart. Apart from this, valvular diseases are also common among elderly people.

3. Neurological Disorders: Neurological diseases and neurodegenerative changes seen in elderly people may cause dizziness. In elderly people, degenerative alterations in neurons lead to decreased nerve impulse conduction speed and fluctuations in neurotransmitter levels. Additionally, a decline in gray and white matter in the brain results in diminished brain functionality. Also, senile changes in the brain due to lack of blood supply are responsible for dizziness. Such changes are seen in persons suffering from stroke, which causes a lack of blood supply in the posterior fossa of the brain and in the cerebellum. Neurological disorders such as Parkinson's disease, Alzheimer's disease, and multiple sclerosis are also responsible for such conditions. The death of neurons and changes in the level of neurotransmitters are related to such changes. Migraine, which is associated with the enlargement of blood vessels in the brain and the activation of the trigeminovascular neurons, may also cause dizziness.

4. Peripheral Vestibular Disease: These conditions are responsible for the loss of the body’s balance mechanisms. 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 the entrapment of the mineral crystals in the ear canal. Also, fluid build-up in the inner ear may cause such complications. Such conditions are known as Ménière disease.

How to Diagnose Dizziness in Elderly?

The diagnosis of dizziness is done by carefully taking a history. Patients usually complain of weakness and fatigue. They often lose their balance and are unable to walk or talk properly. In some cases, patients complain of sudden darkness or impairment in vision. In some cases, the patient may complain of loss of sensation. The diagnostic tests that help diagnose such conditions are;

1. Pulse and Heart Rate: The patient's pulse and heart rate are examined. An electrocardiogram is a useful method to detect any cardiac changes. Also, fluctuations in the heart rate are evaluated in both erect and supine positions.

2. Nystagmus: Nystagmus or rapid eye movement can be useful in distinguishing central and peripheral causes of vertigo. In cases of peripheral vertigo, nystagmus typically moves horizontally and in one direction, with the quick phase moving away from the affected area. The nystagmus can be suppressed with visual fixation. Tinnitus and hearing loss may also occur. On the other hand, central vertigo can result in nystagmus that moves in any direction. Vertical or purely torsional nystagmus is commonly linked to central issues, often accompanied by focal neurological symptoms.

3. Neurological Examination: Neurological examinations are useful for the assessment of the functionality of the cranial nerves.

4. Physical Examination: Physical assessment of the patient is important. Assessment of the gait of the patient and hearing tests are essential in such cases.

5. Provocation Tests: This test is also known as the Dixie-Hallpike maneuver. This is done to detect the presence of benign paroxysmal positional vertigo (BPPV).

What Are the Treatment Options for Dizziness in Elderly?

The treatment options in such cases depend upon the causative factors. Drugs like anti-emetics and vestibular sedatives such as Prochlorperazine and Cyclizine can be used to treat symptoms. However, the treatment of actual causes is more beneficial for a longer duration or for successful outcomes. Lifestyle changes such as;

1. Maintenance of the blood pressure and intake of a low-salt diet are useful.

2. Thigh-high thrombo-embolic deterrent (TED) stockings are useful in preventing a sudden change in blood pressure.

3. Patients should not consume nicotine and caffeine.

4. Stressful events may worsen the condition of the patient.

Conclusion:

Dizziness is a common problem seen in the elderly population. Different heart diseases, fluctuation in blood pressure, neurological diseases, and vestibular diseases cause this complication. Dizziness often causes loss of body balance, fainting, and weakness. It is responsible for the deterioration of quality of life. As a result, identifying the causative factors and proper treatment is essential to cure this.