Dizziness in the elderly may not have one easily identifiable
cause, but many contributing factors that need to be observed
closely, researchers say.
According to a new report, about one-quarter of elderly people
living in the community (i.e., not in nursing homes or other
facilities) experience dizziness that is not the direct result of
an illness. However, in the study, no one factor or precipitating
cause stood out as a consistent predictor of dizziness.
The study authors explained that, in this way, dizziness may be
similar to other ``geriatric syndromes,'' such as falling, delirium
and urinary incontinence, which also have multiple causes.
Researchers led by Dr. Thomas Gill, associate professor of
internal medicine geriatrics at Yale University School of Medicine
in New Haven, Conn., studied 1087 community-living elderly people,
ages 72 and older. The investigators questioned these people about
their medical histories, particularly about experiences with
dizziness. They found that 310 people (29 percent) reported having
felt dizzy within the two months before the interview, and 261 (24
percent) said that the dizziness had lasted, intermittently, at
least one month.
A variety of medical factors contributed to dizziness, the
researchers found. These included anxiety, depressive symptoms,
impaired hearing, taking five or more medications, low blood
pressure when moving from the sitting to standing position,
impaired balance and having had a heart attack in the past.
Individually, each of these factors increased the chances of
becoming dizzy anywhere from 27 percent to 69 percent. And the more
symptoms a person had, the more likely he or she was to have
reported dizziness: For each extra factor a person had, the chances
of dizziness increased by 38 percent.
The report is published in the March 7 issue of Annals of
Internal Medicine.
``Although we cannot establish a temporal or cause-effect
relation between these characteristics and dizziness, a relation
between each characteristic and dizziness is biologically
plausible, and each has been associated with dizziness in one or
more previous studies,'' the researchers wrote.
``Dizziness is often distressing to patients and frustrating to
physicians because patients have trouble articulating their
symptoms precisely and physicians have difficulty identifying and
treating a specific disease responsible for the symptom,'' wrote
Dr. David Drachman, a professor of neurology at the University of
Massachusetts Medical School in Worcester, Mass. Drachman authored
an editorial that accompanied the report.
``For physicians who still cling to the misapprehension that
dizziness is synonymous with vertigo and is invariably due to a
disorder of the inner ear,'' Drachman continued, ``this article
should draw their attention to the broader nature of the symptom
and the diversity of conditions that may cause it.''
He emphasized that diagnosing dizziness in the elderly will
require a certain amount of time and effort before determining an
appropriate course of treatment. ``The 17-minute managed-care visit
will rarely suffice for evaluating the elderly patient with
dizziness,'' he wrote.
