Vertigo living in older adults

Overview

Vertigo is a false sense of spinning or movement. It is a symptom, not a disease itself. It can make you feel like you or your surroundings are moving when they are not. Vertigo often comes from a problem in the inner ear or the balance centers of the brain.

Yes, vertigo is very common in older adults. About 30% of people over age 65 have experienced dizziness, and vertigo is one of the main reasons older adults visit their doctor.

It most often affects people over 60, especially those with a history of head injury, migraines, or inner ear problems. Women are slightly more likely to develop certain types of vertigo, such as BPPV.

Symptoms

Common symptoms

• A spinning or whirling sensation
• Feeling unsteady or off-balance
• Nausea or vomiting
• Sweating
• Headache or sensitivity to light and sound

Symptoms in children

• This article focuses on older adults, but in children vertigo may show as sudden crying, clinging to a parent, or refusing to move the head.

Symptoms in older adults

• Increased risk of falls and injury
• Difficulty walking or standing without support
• Feeling faint or lightheaded (sometimes confused with vertigo)
• Anxiety or fear of moving because of dizziness

Causes

Main causes

• Benign paroxysmal positional vertigo (BPPV) – tiny crystals in the inner ear become dislodged
• Vestibular neuritis – inflammation of the inner ear nerve, often after a viral infection
• Meniere's disease – a buildup of fluid in the inner ear that causes vertigo, tinnitus, and hearing loss
• Migraine-associated vertigo – migraines that cause dizziness even without headache
• Reduced blood flow to the inner ear or brain (e.g., from atherosclerosis)

Risk factors

• Age 60 and older
• Previous head injury or ear infection
• High blood pressure, diabetes, or heart disease
• Migraines
• Family history of inner ear disorders

When to see a doctor

See a doctor urgently if:

• If you have vertigo along with any emergency symptoms (sudden weakness, trouble speaking, chest pain)
• If you have vertigo after a fall or head injury
• If you cannot stand or walk

Book a routine appointment if:

• If you have repeated episodes of vertigo that affect your daily life
• If vertigo is new, persistent, or bothersome
• To find out the cause and get treatment to prevent falls

Diagnosis

Your doctor will ask about your symptoms, medical history, and any medicines you take. They may perform simple tests to check your balance and eye movements. A common test for BPPV is the Dix-Hallpike maneuver, where your head is moved in specific positions to see if it triggers vertigo and eye twitching.

Tests that may be done

• Physical exam and balance test (e.g., standing on one foot, walking in a straight line)
• Dix-Hallpike maneuver (for BPPV)
• Hearing test (audiometry)
• Electronystagmography (ENG) or videonystagmography (VNG) – records eye movements
• MRI or CT scan of the head (if a brain cause is suspected)

What to expect at your appointment

Most vertigo is diagnosed in a doctor's office without need for scans. If BPPV is found, the doctor may treat it by performing a simple repositioning maneuver (like the Epley maneuver) right there. If further tests are needed, they will explain the steps. You may be referred to an ear, nose, and throat (ENT) specialist or a physical therapist who specializes in balance.

Treatment

Treatment depends on the cause. Many types of vertigo improve on their own or with simple head movements. Medicines can help with nausea, but they do not cure the condition. Physical therapy (vestibular rehabilitation) is very helpful for older adults to retrain the brain's balance system.

Self-care at home

• Avoid sudden head movements – move slowly when getting up or turning over in bed.
• Stay well hydrated and eat regular meals to avoid low blood sugar.
• Use good lighting and hold onto handrails when walking.
• If you have BPPV, try the Epley maneuver at home as instructed by your doctor or physical therapist.
• Get up slowly from lying down to sitting, then to standing, to avoid sudden dizziness.

Medical treatments

Your doctor may prescribe medicines that calm the inner ear or reduce nausea. Sometimes an antibiotic or antiviral medicine is used if the cause is an infection. For Meniere's disease, a low-salt diet and diuretics may help. Do not start or stop any medicine without talking to your doctor.

When is surgery considered?

Surgery is rarely needed. It may be considered for severe, disabling vertigo that does not respond to other treatments, such as in some cases of Meniere's disease or a perilymphatic fistula (a tear in the inner ear's lining). Your doctor will discuss risks and benefits if surgery is an option.

Living with this condition

Living with vertigo can be challenging, but many people manage it well. Learn what triggers your vertigo and avoid those positions or activities. Plan rest breaks if you feel dizzy. Make your home safer to prevent falls – remove loose rugs, install grab bars in the bathroom, and keep pathways clear.

Lifestyle tips

• Get regular, gentle exercise like walking or tai chi to improve balance.
• Sleep with your head slightly elevated on two pillows if BPPV is a problem.
• Avoid sudden head-turning, bending over, or looking up for long periods.
• If you feel a dizzy spell coming on, sit down immediately and hold onto something stable.

Diet and exercise

Eat a balanced diet with plenty of fluids. Some people find that reducing salt, caffeine, and alcohol helps with certain types of vertigo. Gentle exercises like head turns and eye movements (under the guidance of a therapist) can retrain your balance system.

Mental health and emotional wellbeing

Vertigo can cause anxiety, fear of falling, and even depression. Feeling dizzy makes you avoid activities, which can lead to isolation. Talk to your doctor if vertigo is affecting your mood – they can offer support or refer you to a counsellor.

Prevention

Not all vertigo can be prevented, but you can lower your risk: stay active to maintain good balance, avoid head injuries by using seat belts and handrails, and treat conditions like high blood pressure and diabetes. If you have BPPV, learning to avoid certain head positions may prevent episodes.

Complications

If left untreated

• Falls and related injuries (fractures, head injury)
• Difficulty walking or moving around, leading to loss of independence
• Chronic anxiety or panic attacks related to dizziness
• Social withdrawal and depression

Long-term outlook

The outlook for vertigo in older adults is generally good. With proper diagnosis and treatment, most people improve significantly. BPPV often resolves with simple repositioning maneuvers. Vestibular rehabilitation therapy can help retrain your brain to compensate for inner ear problems. While some conditions like Meniere's disease may have flare-ups, many people learn to manage them and continue enjoying life.

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