Dizziness in the elderly

Otolaryngologic Clinics of North America

Volumn 44, Issue 2, 2011, Pages 437-454

  Barin, Kamran ^a   Dodson, Edward E ^a  

^a THE OHIO STATE UNIVERSITY WEXNER MEDICAL CENTER   (United States)

Author keywords

Age related dizziness; Disequilibrium of aging; Falls in older adults; Vestibular disorders

Indexed keywords

AGED; ANXIETY; BENIGN PAROXYSMAL POSITIONAL VERTIGO; CASE REPORT; CATARACT; CLINICAL ASSESSMENT; COGNITION; COMPUTER ASSISTED TOMOGRAPHY; CONGESTIVE HEART FAILURE; DEPRESSION; DISABILITY; DIZZINESS; ELDERLY CARE; ELECTRONYSTAGMOGRAPHY; FEMALE; HEARING LOSS; HUMAN; HYPERTENSION; INCONTINENCE; LACERATION; MAGNETIC RESONANCE ANGIOGRAPHY; MEDICAL HISTORY; MOTOR COORDINATION; MUSCLE STRENGTH; MUSCLE TONE; NUCLEAR MAGNETIC RESONANCE IMAGING; OSTEOPOROSIS; PRESYNCOPE; REVIEW; RHEUMATOID ARTHRITIS; VERTIGO; VESTIBULAR EVOKED MYOGENIC POTENTIAL; VESTIBULAR TEST; VISUAL ACUITY;

ACCIDENTAL FALLS; AGED, 80 AND OVER; COMORBIDITY; DIZZINESS; FEMALE; HUMANS; LIFE STYLE; MAGNETIC RESONANCE IMAGING; POSTURAL BALANCE; PROPRIOCEPTION; VESTIBULAR FUNCTION TESTS; VESTIBULE, LABYRINTH; VISUAL ACUITY;

EID: 79953305465     PISSN: 00306665     EISSN: None     Source Type: Journal    
DOI: 10.1016/j.otc.2011.01.013     Document Type: Review

References (92)

1. Jönsson R., Sixt E., Landahl S., et al. Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res 2004, 14(1):47-52.
2. Neuhauser H., von Brevern M., Radtke A., et al. Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology 2005, 65(6):898-904.
3. Tinetti M., Williams C. Falls, injuries due to falls, and the risk of admission to a nursing home. N Engl J Med 1997, 337(18):1279-1284.
4. Kannus P., Parkkari J., Koskinen S., et al. Fall-induced injuries and deaths among older adults. JAMA 1999, 281(20):1895-1899.
5. " Falls among older adults: an overview" Available at:, Accessed August 14, 2010. http://www.cdc.gov/HomeandRecreationalSafety/Falls/adultfalls.html.
6. Tinetti M., Williams C., Gill T. Dizziness among older adults: a possible geriatric syndrome. Ann Intern Med 2000, 132(5):337-344.
7. Sloane P., Baloh R. Persistent dizziness in geriatric patients. J Am Geriatr Soc 1989, 37(11):1031-1038.
8. Neuhauser H. Epidemiology of vertigo. Curr Opin Neurol 2007, 20(1):40-46.
9. Maarsingh O., Dros J., Schellevis F., et al. Dizziness reported by elderly patients in family practice: prevalence, incidence, and clinical characteristics. BMC Fam Pract 2010, 11:2.
10. Graafmans W., Ooms M., Hofstee H., et al. Falls in the elderly: a prospective study of risk factors and risk profiles. Am J Epidemiol 1996, 143(11):1129-1136.
11. O'Loughlin J., Boivin J., Robitaille Y., et al. Falls among the elderly: distinguishing indoor and outdoor risk factors in Canada. J Epidemiol Community Health 1994, 48(5):488-489.
12. Rubenstein L., Josephson K. The epidemiology of falls and syncope. Clin Geriatr Med 2002, 18(2):141-158.
13. King M., Tinetti M. Falls in community-dwelling older persons. J Am Geriatr Soc 1995, 43(10):1146-1154.
14. Alexander B., Rivara F., Wolf M. The cost and frequency of hospitalization for fall-related injuries in older adults. Am J Public Health 1992, 82(7):1020-1023.
15. Stevens J., Corso P., Finkelstein E., et al. The costs of fatal and non-fatal falls among older adults. Inj Prev 2006, 12(5):290-295.
16. " Costs of falls among older adults" Available at:, Accessed August 14, 2010. http://www.cdc.gov/HomeandRecreationalSafety/Falls/fallcost.html.
17. Stel V., Pluijm S., Deeg D., et al. A classification tree for predicting recurrent falling in community-dwelling older persons. J Am Geriatr Soc 2003, 51(10):1356-1364.
18. Whitney S., Marchetti G., Schade A. The relationship between falls history and computerized dynamic posturography in persons with balance and vestibular disorders. Arch Phys Med Rehabil 2006, 87(3):402-407.
19. Moreland J., Richardson J., Goldsmith C., et al. Muscle weakness and falls in older adults: a systematic review and meta-analysis. J Am Geriatr Soc 2004, 52(7):1121-1129.
20. Rubenstein L., Josephson K. Falls and their prevention in elderly people: what does the evidence show?. Med Clin North Am 2006, 90(5):807-824.
21. Burker E., Wong H., Sloane P., et al. Predictors of fear of falling in dizzy and nondizzy elderly. Psychol Aging 1995, 10(1):104-110.
22. Perez-Jara J., Enguix A., Fernandez-Quintas J., et al. Fear of falling among elderly patients with dizziness and syncope in a tilt setting. Can J Aging 2009, 28(2):157-163.
23. Holmberg J., Karlberg M., Harlacher U., et al. Experience of handicap and anxiety in phobic postural vertigo. Acta Otolaryngol 2005, 125(3):270-275.
24. Delbaere K., Crombez G., Vanderstraeten G., et al. Fear-related avoidance of activities, falls and physical frailty. A prospective community-based cohort study. Age Ageing 2004, 33(4):368-373.
25. Li F., Fisher K., Harmer P., et al. Fear of falling in elderly persons: association with falls, functional ability, and quality of life. J Gerontol B Psychol Sci Soc Sci 2003, 58(5):P283-P290.
26. Belal A., Glorig A. Dysequilibrium of ageing (presbyastasis). J Laryngol Otol 1986, 100(9):1037-1041.
27. Lawson J., Fitzgerald J., Birchall J., et al. Diagnosis of geriatric patients with severe dizziness. J Am Geriatr Soc 1999, 47(1):12-17.
28. Sloane P. Evaluation and management of dizziness in the older patient. Clin Geriatr Med 1996, 12(4):785-801.
29. Katsarkas A. Dizziness in aging: the clinical experience. Geriatrics 2008, 63(11):18-20.
30. Bueno-Cavanillas A., Padilla-Ruiz F., Jiménez-Moleón J., et al. Risk factors in falls among the elderly according to extrinsic and intrinsic precipitating causes. Eur J Epidemiol 2000, 16(9):849-859.
31. Rosenhall U., Rubin W. Degenerative changes in the human vestibular sensory epithelia. Acta Otolaryngol 1975, 79(1/2):67-80.
32. Richter E. Quantitative study of human Scarpa's ganglion and vestibular sensory epithelia. Acta Otolaryngol 1980, 90(3/4):199-208.
33. Merchant S., Velázquez-Villaseñor L., Tsuji K., et al. Temporal bone studies of the human peripheral vestibular system. Normative vestibular hair cell data. Ann Otol Rhinol Laryngol Suppl 2000, 181:3-13.
34. Ishiyama G. Imbalance and vertigo: the aging human vestibular periphery. Semin Neurol 2009, 29(5):491-499.
35. Ishiyama A., Lopez I., Ishiyama G., et al. Unbiased quantification of the microdissected human Scarpa's ganglion neurons. Laryngoscope 2004, 114(8):1496-1499.
36. Lopez I., Ishiyama G., Tang Y., et al. Estimation of the number of nerve fibers in the human vestibular endorgans using unbiased stereology and immunohistochemistry. J Neurosci Methods 2005, 145(1/2):37-46.
37. Tang Y., Lopez I., Baloh R. Age-related change of the neuronal number in the human medial vestibular nucleus: a stereological investigation. J Vestib Res 2001, 11(6):357-363. 2001-2.
38. Lyon M., Davis J. Age-related blood flow and capillary changes in the rat utricular macula: a quantitative stereological and microsphere study. J Assoc Res Otolaryngol 2002, 3(2):167-173.
39. Lyon M., Wanamaker H. Blood flow and assessment of capillaries in the aging rat posterior canal crista. Hear Res 1993, 67(1/2):157-165.
40. Johnsson L., Hawkins J. Vascular changes in the human inner ear associated with aging. Ann Otol Rhinol Laryngol 1972, 81(3):364-376.
41. Peterka R., Black F., Schoenhoff M. Age-related changes in human vestibulo-ocular reflexes: sinusoidal rotation and caloric tests. J Vestib Res 1990, 1(1):49-59. 1990-1.
42. Kerber K., Ishiyama G., Baloh R. A longitudinal study of oculomotor function in normal older people. Neurobiol Aging 2006, 27(9):1346-1353.
43. Baloh R., Enrietto J., Jacobson K., et al. Age-related changes in vestibular function: a longitudinal study. Ann N Y Acad Sci 2001, 942:210-219.
44. Furman J., Redfern M. Effect of aging on the otolith-ocular reflex. J Vestib Res 2001, 11(2):91-103.
45. Jacobson G., McCaslin D., Grantham S., et al. Significant vestibular system impairment is common in a cohort of elderly patients referred for assessment of falls risk. J Am Acad Audiol 2008, 19(10):799-807.
46. Katsarkas A. Dizziness in aging: a retrospective study of 1194 cases. Otolaryngol Head Neck Surg 1994, 110(3):296-301.
47. Fitzpatrick R., McCloskey D. Proprioceptive, visual and vestibular thresholds for the perception of sway during standing in humans. J Physiol 1994, 478(Pt 1):173-186.
48. Behm D., Bambury A., Cahill F., et al. Effect of acute static stretching on force, balance, reaction time, and movement time. Med Sci Sports Exerc 2004, 36(8):1397-1402.
49. Wiles P., Pearce S., Rice P., et al. Vibration perception threshold: influence of age, height, sex, and smoking, and calculation of accurate centile values. Diabet Med 1991, 8(2):157-161.
50. Sturnieks D., St George R., Lord S. Balance disorders in the elderly. Neurophysiol Clin 2008, 38(6):467-478.
51. Peterka R., Black F. Age-related changes in human posture control: sensory organization tests. J Vestib Res 1990, 1(1):73-85. 1990-1.
52. Horak F., Dickstein R., Peterka R. Diabetic neuropathy and surface sway-referencing disrupt somatosensory information for postural stability in stance. Somatosens Mot Res 2002, 19(4):316-326.
53. Lord S., Clark R., Webster I. Physiological factors associated with falls in an elderly population. J Am Geriatr Soc 1991, 39(12):1194-1200.
54. Bove M., Courtine G., Schieppati M. Neck muscle vibration and spatial orientation during stepping in place in humans. J Neurophysiol 2002, 88(5):2232-2241.
55. Deshpande N., Patla A. Postural responses and spatial orientation to neck proprioceptive and vestibular inputs during locomotion in young and older adults. Exp Brain Res 2005, 167(3):468-474.
56. Patel M., Fransson P., Karlberg M., et al. Change of body movement coordination during cervical proprioceptive disturbances with increased age. Gerontology 2010, 56(3):284-290.
57. Malmström E., Karlberg M., Fransson P., et al. Cervical proprioception is sufficient for head orientation after bilateral vestibular loss. Eur J Appl Physiol 2009, 107(1):73-81.
58. Lord S., Clark R., Webster I. Visual acuity and contrast sensitivity in relation to falls in an elderly population. Age Ageing 1991, 20(3):175-181.
59. Lord S. Visual risk factors for falls in older people. Age Ageing 2006, 35(Suppl 2):ii42-ii45.
60. Haegerstrom-Portnoy G., Morgan M.W. Normal age-related vision changes. Vision and aging 2007, 31-48. Butterworth-Heinemann, St Louis (MO). A.A. Rosenbloom, M.V. Morgan (Eds.).
61. Ishigaki H., Miyao M. Implications for dynamic visual acuity with changes in aged and sex. Percept Mot Skills 1994, 78(2):363-369.
62. Schubert M., Herdman S., Tusa R. Vertical dynamic visual acuity in normal subjects and patients with vestibular hypofunction. Otol Neurotol 2002, 23(3):372-377.
63. Poulain I., Giraudet G. Age-related changes of visual contribution in posture control. Gait Posture 2008, 27(1):1-7.
64. Borger L., Whitney S., Redfern M., et al. The influence of dynamic visual environments on postural sway in the elderly. J Vestib Res 1999, 9(3):197-205.
65. O'Connor K., Loughlin P., Redfern M., et al. Postural adaptations to repeated optic flow stimulation in older adults. Gait Posture 2008, 28(3):385-391.
66. Larsson L., Ramamurthy B. Aging-related changes in skeletal muscle. Mechanisms and interventions. Drugs Aging 2000, 17(4):303-316.
67. Faulkner J., Larkin L., Claflin D., et al. Age-related changes in the structure and function of skeletal muscles. Clin Exp Pharmacol Physiol 2007, 34(11):1091-1096.
68. Roos M., Rice C., Vandervoort A. Age-related changes in motor unit function. Muscle Nerve 1997, 20(6):679-690.
69. Peterka R., Black F. Age-related changes in human posture control: motor coordination tests. J Vestib Res 1990, 1(1):87-96. 1990-1.
70. Moschner C., Baloh R. Age-related changes in visual tracking. J Gerontol 1994, 49(5):M235-M238.
71. McPherson D., Whitaker S., Wrobel B. DDX: Disequilibrium of aging. Practical management of the dizzy patient 2008, 297-344. Lippincott Williams & Wilkins, Philadelphia. J.A. Goebel (Ed.).
72. Quoniam C., Hay L., Roll J., et al. Age effects on reflex and postural responses to propriomuscular inputs generated by tendon vibration. J Gerontol A Biol Sci Med Sci 1995, 50(3):B155-B165.
73. Maarsingh O., Dros J., Schellevis F., et al. Causes of persistent dizziness in elderly patients in primary care. Ann Fam Med 2010, 8(3):196-205.
74. Drachman D. A 69-year-old man with chronic dizziness. JAMA 1998, 280(24):2111-2118.
75. Baloh R. Dizziness in older people. J Am Geriatr Soc 1992, 40(7):713-721.
76. Sloane P., Hartman M., Mitchell C. Psychological factors associated with chronic dizziness in patients aged 60 and older. J Am Geriatr Soc 1994, 42(8):847-852.
77. Eckhardt-Henn A., Breuer P., Thomalske C., et al. Anxiety disorders and other psychiatric subgroups in patients complaining of dizziness. J Anxiety Disord 2003, 17(4):369-388.
78. Ganz D., Bao Y., Shekelle P., et al. Will my patient fall?. JAMA 2007, 297(1):77-86.
79. Agostini J., Tinetti M. Drugs and falls: rethinking the approach to medication risk in older adults. J Am Geriatr Soc 2002, 50(10):1744-1745.
80. Menant J., St George R., Sandery B., et al. Older people contact more obstacles when wearing multifocal glasses and performing a secondary visual task. J Am Geriatr Soc 2009, 57(10):1833-1838.
81. Haran M., Cameron I., Ivers R., et al. Effect on falls of providing single lens distance vision glasses to multifocal glasses wearers: VISIBLE randomised controlled trial. BMJ 2010, 340:c2265.
82. Domínguez M., Magro J. Bedside balance testing in elderly people. Curr Aging Sci 2009, 2(2):150-157.
83. Kerber K. Dizziness in older people. Vertigo and imbalance: clinical neurophysiology of the vestibular system 2010, 9. Elsevier, Philadelphia, 491-501. S.D. Eggers, D.S. Zee (Eds.).
84. Aw S., Halmagyi G., Black R., et al. Head impulses reveal loss of individual semicircular canal function. J Vestib Res 1999, 9(3):173-180.
85. Newman-Toker D., Kattah J., Alvernia J., et al. Normal head impulse test differentiates acute cerebellar strokes from vestibular neuritis. Neurology 2008, 70(24 Pt 2):2378-2385.
86. Square wave jerks (SWJ) Available at:, Accessed August 14, 2010. http://www.dizziness-and-balance.com/practice/nystagmus/SWJ.htm.
87. Barin K. Interpretation and usefulness of caloric testing. Balance function assessment and management 2008, 229-252. Plural Publishing, San Diego (CA). G. Jacobson, N. Shepard (Eds.).
88. Janky K., Shepard N. Vestibular evoked myogenic potential (VEMP) testing: normative threshold response curves and effects of age. J Am Acad Audiol 2009, 20(8):514-522.
89. Tseng C., Chou C., Young Y. Aging effect on the ocular vestibular-evoked myogenic potentials. Otol Neurotol 2010, 31(6):959-963.
90. Nguyen K., Welgampola M., Carey J. Test-retest reliability and age-related characteristics of the ocular and cervical vestibular evoked myogenic potential tests. Otol Neurotol 2010, 31(5):793-802.
91. Brantberg K., Granath K., Schart N. Age-related changes in vestibular evoked myogenic potentials. Audiol Neurootol 2007, 12(4):247-253.
92. Lee S., Cha C., Jung T., et al. Age-related differences in parameters of vestibular evoked myogenic potentials. Acta Otolaryngol 2008, 128(1):66-72.