Dizziness and nausea are frequently reported symptoms among older individuals. While these sensations can be disorienting, understanding their various contributing factors is a helpful initial step. These symptoms often stem from underlying issues, and identifying the causes can guide appropriate interventions to improve well-being.
Common and Treatable Factors
Dehydration is a common cause of dizziness and nausea in older adults. Insufficient fluid intake or excessive fluid loss, such as from fever or diarrhea, can reduce blood volume. This decrease impacts oxygen delivery to the brain, causing lightheadedness and stomach upset. Even mild dehydration can result in fatigue and headaches, while severe cases may cause confusion or disorientation.
Orthostatic hypotension, a sudden drop in blood pressure upon standing, frequently causes dizziness. When transitioning from sitting or lying to standing, blood pools in the lower extremities, reducing blood flow to the brain. Normally, the body compensates by narrowing blood vessels and increasing heart rate. However, this mechanism may be delayed or impaired in older individuals, resulting in brief spells of dizziness or lightheadedness.
Hypoglycemia, or low blood sugar, particularly affects those with diabetes or irregular eating patterns. When blood glucose levels fall below 70 milligrams per deciliter, the brain is deprived of its primary energy source. This leads to symptoms like dizziness, confusion, sweating, and anxiety. These symptoms can be subtle or atypical in older adults, sometimes mistaken for general fatigue or cognitive changes.
Anemia, a reduction in red blood cells or hemoglobin, impairs the blood’s ability to carry oxygen throughout the body. When the brain receives inadequate oxygen, dizziness and nausea can occur. Anemia can also cause fatigue, weakness, pale skin, and shortness of breath, increasing the risk of falls.
Inner Ear and Balance System Disorders
Benign Paroxysmal Positional Vertigo (BPPV)
Benign Paroxysmal Positional Vertigo (BPPV) is a common inner ear disorder causing sudden, brief episodes of vertigo. It occurs when tiny calcium carbonate crystals, called otoconia, dislodge from their normal position and migrate into the semicircular canals. These displaced crystals abnormally stimulate hair cells, sending confusing signals to the brain about head movement. This results in a spinning sensation, often accompanied by nausea and vomiting, especially with specific head movements.
Meniere’s Disease
Meniere’s Disease is an inner ear disorder characterized by episodes of vertigo, tinnitus, fluctuating hearing loss, and a feeling of fullness or pressure in the affected ear. The exact cause is unknown, but it is thought to involve an abnormal buildup of fluid, called endolymph, in the inner ear. These attacks can last from 20 minutes to several hours. While vertigo may become less frequent in later stages, hearing and balance problems can persist.
Vestibular Neuritis or Labyrinthitis
Vestibular Neuritis or Labyrinthitis involve inflammation of the inner ear or the vestibular nerve, often following a viral infection. Vestibular neuritis primarily affects the balance nerve, causing sudden, intense, and constant vertigo, often with nausea and vomiting, but typically without hearing loss. Labyrinthitis, a broader inflammation, presents with similar vertigo symptoms but also includes temporary hearing loss and tinnitus because it affects both balance and hearing structures.
Medication Side Effects and Interactions
Medications frequently contribute to dizziness and nausea in older adults, who often take multiple prescriptions. Certain drug classes can directly induce these symptoms as side effects. Blood pressure medications, such as diuretics, beta-blockers, and alpha-blockers, can lower blood pressure excessively, leading to lightheadedness and dizziness. Sedatives, tranquilizers like benzodiazepines, and antidepressants, including tricyclic antidepressants and selective serotonin reuptake inhibitors (SSRIs), can cause drowsiness, impaired coordination, and unsteadiness. Some pain relievers, including opioids and certain anti-inflammatories, also list dizziness as a common side effect.
Drug interactions, where medications taken concurrently amplify adverse effects, present a concern. For example, combining opioids and benzodiazepines can increase drowsiness and dizziness, raising the risk of falls. Certain antibiotics, when taken with drugs like digoxin, can elevate digoxin levels, leading to symptoms such as nausea, vomiting, and vision changes. The more medications a person takes, the higher the likelihood of experiencing medication-related dizziness, with increased risk when taking three or more drugs.
Underlying Medical Conditions
Cardiovascular conditions
Cardiovascular conditions significantly impact blood flow to the brain, potentially causing dizziness and nausea. Arrhythmias, or irregular heartbeats, can lead to palpitations, lightheadedness, and even fainting due to inefficient blood pumping. Heart failure, where the heart struggles to pump blood effectively, can result in reduced oxygen delivery to the brain, causing dizziness, fatigue, and sometimes nausea.
Neurological conditions
Neurological conditions can also disrupt the brain’s balance centers, leading to these symptoms. Stroke can impair brain function that controls balance and coordination, manifesting as dizziness and unsteadiness. Parkinson’s disease, a neurodegenerative disorder, often involves motor symptoms like tremors and postural instability, which can lead to difficulty maintaining balance and increased fall risk. Multiple sclerosis, an autoimmune disease affecting the central nervous system, can cause nerve damage that impacts balance and coordination, leading to dizziness and an unsteady gait.
Infections
Infections can cause generalized malaise and contribute to dizziness and nausea. Urinary tract infections (UTIs) may present with atypical symptoms, including confusion, fatigue, and dizziness. Pneumonia, a lung infection, can lead to severe shortness of breath and reduced oxygen to organs. This can result in confusion, dizziness, and general weakness.
Anxiety and stress
Anxiety and stress, while psychological in origin, can manifest with significant physical symptoms. Chronic stress can affect the cardiovascular system, narrowing blood vessels and increasing heart rate, which may induce dizziness or lightheadedness. Anxiety disorders can cause a range of physical sensations, including shakiness, sweating, headaches, chest pain, and nausea.