Optimization of approaches to the diagnosis and treatment of vestibular vertigo in geriatric practice. Analytical review of the Expert Council resolution

At the Expert Council meeting on June 26, 2026, the issues of diagnosis and treatment of vestibular vertigo in the elderly were discussed. It was noted that the causes of peripheral vestibular vertigo in the elderly are most often benign paroxysmal positional vertigo, Meniere's disease, bilateral vestibulopathy, and presbyvestibulopathy. The most common causes of central dizziness are transient ischemic attacks, strokes, and migraine-associated dizziness. These common causes of dizziness are often undiagnosed; many elderly patients have an erroneous diagnosis of chronic cerebral ischemia, vertebrobasilar insufficiency, or cervical osteochondrosis and do not receive effective treatment. The management of elderly patients is based on the identification and effective treatment of the causes of vertigo, the use of vestibular rehabilitation, the correction of sensory deficits, and the identification and effective treatment of concomitant diseases. When selecting drug therapy, strict prevention of polypharmacy and adherence to safety criteria with minimization of the use of drugs that increase the risk of falls and cognitive impairment are of key importance. As a pharmacological potentiation of central adaptation, the use of betahistine dihydrochloride (for example, Betaserc Long 48 mg, a dosage form for once-daily administration) is justified. The development of specialty-specific clinical recommendations and standards for the management of elderly patients with vertigo and balance disorders is of great importance, which will reduce the risks of falls and improve the functional activity of patients.