Dizziness is a frequent complaint among older adults, affecting 20% to 30% of individuals over 60 and rising to about 50% in those over 85. It impacts quality of life, mobility, and independence, and is a strong predictor of falls. Dizziness is a symptom of an underlying issue, not an inevitable part of aging.
Age-Related Bodily Changes
As individuals age, physiological changes occur across various bodily systems that can contribute to dizziness. The inner ear’s balance system, the vestibular system, undergoes deterioration with age. A decrease in vestibular hair cells and neurons after age 55 can lead to balance problems, such as difficulty walking or standing, particularly in low-light conditions or on uneven surfaces.
The cardiovascular system also experiences age-related shifts, impacting blood pressure regulation. The heart’s efficiency in pumping blood throughout the body can decline, resulting in sudden drops in blood pressure upon standing, a condition known as orthostatic hypotension. This rapid change in blood pressure can cause brief episodes of dizziness. Additionally, the body’s ability to sense and respond to changes in position, known as proprioception, can be affected by decreased nerve function, such as peripheral neuropathy.
Vision changes common in older age further contribute to balance challenges. The visual system plays a significant role in maintaining postural stability, and impaired vision can disrupt this intricate balance. When multiple sensory inputs that contribute to balance – vestibular, proprioceptive, and visual – become less efficient, the risk of experiencing dizziness increases.
Medication-Induced Dizziness
Medications frequently prescribed to older adults can be a significant cause of dizziness, often due to polypharmacy, which refers to the concurrent use of multiple drugs, typically defined as four or more. Older individuals often exhibit increased sensitivity to medications because of age-related changes in how drugs are processed by the body. This heightened sensitivity makes them more susceptible to adverse drug events, including dizziness.
Several classes of medications are commonly implicated in causing dizziness. Antihypertensive drugs, used to manage high blood pressure, can lead to orthostatic hypotension, a sudden drop in blood pressure when changing positions. Diuretics, which are a type of blood pressure medication, can also cause dizziness by leading to volume depletion and electrolyte imbalances. Central nervous system (CNS) depressants, such as sedatives, anti-anxiety medications (anxiolytics), antidepressants, anticonvulsants, and hypnotics, can induce dizziness by reducing mental alertness, slowing CNS transmission, and impairing coordination.
Pain relievers, particularly opioids, are another class of drugs that can result in dizziness. Beyond single medications, interactions between various prescription drugs, over-the-counter medications, and even herbal supplements can trigger dizziness. The complexity of managing multiple chronic conditions often necessitates polypharmacy, making medication-induced dizziness a common and challenging issue in older adults.
Underlying Health Conditions
Dizziness in older adults frequently signals an underlying medical condition impacting various body systems. Cardiovascular issues are a common cause, with orthostatic hypotension—a sudden drop in blood pressure upon standing—being a prevalent contributor. Other cardiac problems, such as arrhythmias, heart attack, or heart failure, can reduce blood flow to the brain and inner ear, leading to dizziness. Indeed, cardiovascular disease is identified as a primary cause of dizziness in over half of elderly patients seen in primary care.
Neurological conditions also play a role in causing dizziness and balance issues. Strokes, including transient ischemic attacks (TIAs), and degenerative disorders such as Parkinson’s disease, multiple sclerosis, and cerebellar ataxias, can impair the brain’s ability to process balance signals. Damage to the vestibular pathways within the brain can result in central vertigo, a type of dizziness originating from the central nervous system.
Inner ear (vestibular) disorders are another significant category. Benign Paroxysmal Positional Vertigo (BPPV) is the most common vestibular condition in older adults, characterized by brief, intense spinning sensations triggered by specific head movements due to dislodged calcium crystals. Meniere’s disease, involving fluid buildup in the inner ear, causes episodic dizziness accompanied by hearing loss and ringing in the ears. Labyrinthitis or vestibular neuritis, often caused by viral infections, can lead to sudden and severe dizziness.
Beyond these categories, other health issues can also induce dizziness. Dehydration is a direct cause, impacting overall physiological function. Anemia, characterized by low iron levels, reduces oxygen delivery throughout the body, resulting in dizziness, weakness, and pale skin. Diabetes can contribute through peripheral neuropathy, affecting sensation in the limbs, or through episodes of hypoglycemia, or low blood sugar. Thyroid disorders can also be a factor in the manifestation of dizziness.
When to Seek Professional Advice
It is important to seek medical evaluation if dizziness is persistent, worsens, or appears suddenly and disrupts daily activities, especially if the cause is unclear. While occasional dizziness may not be concerning, certain accompanying symptoms warrant immediate medical attention. These “red flag” signs indicate a potentially serious underlying condition that requires urgent care.
Seek emergency medical care if dizziness occurs with any of the following:
Sudden, severe headache or chest pain.
Rapid or irregular heartbeat.
Numbness, weakness, or trouble moving arms, legs, or face.
Slurred speech or difficulty finding words.
Double vision or sudden changes in vision or hearing.
Difficulty breathing.
Fainting or loss of consciousness.
Severe vomiting or seizures.
Dizziness after a head injury.
A comprehensive medical evaluation is often necessary to determine the specific cause of dizziness, as it can result from a combination of factors.