Vestibular impairment in older people frequently contributes to dizziness as part of a geriatric syndrome

Research to identify whether dizziness is a geriatric syndrome has largely overlooked often treatable vestibular causes. To ascertain the degree to which vestibular and other causes of dizziness interact in older people, an eight-month retrospective case-note review was undertaken in patients aged ≥: 65 years referred with dizziness or imbalance to an audiovestibular medicine clinic. Of 41 patients aged 65-93 years old, 15 (37%) had multiple symptom triggers, 23 (56%) had recent dizziness-related falls, 24 (59%) and 10 (24%) had peripheral and central vestibular causes for dizziness respectively, whereas 6 (15%) had both. Sixteen (39%) had benign paroxysmal positional vertigo, of which 13 (32%) had an additional peripheral vestibular impairment. Twenty-six (63%) had other (general medical/cardiac) causes; of these 13 (50%) also had vestibular causes. Polypharmacy, orthostatic hypotension, psychotropic drug use and anxiety were common contributory factors. Vestibular causes of dizziness contribute to a multifactorial geriatric syndrome. All patients with dizziness and falls should have a vestibular assessment (especially peripheral) to improve quality of life and reduce falls.