Dizziness in Older Adults - Kristin B. PT

As a physical therapist working with primarily geriatric clients I often hear of complaints of “dizziness,” which is very serious as it can be the cause of falls or the cause of a fear of falling. There are many different causes for dizziness in older adults, so it is important for a therapist to ask questions and examine the patient to determine a proper solution.

The first question I ask: “Does it feel like you are light-headed or spinning?”

If the answer is spinning, the patient may be experiencing vertigo which could be related to a vestibular disturbance, especially if the feeling occurs during position changes or turning of the head. If this is the case, a full vestibulo-ocular examination would need to take place to determine the cause and proper course of treatment.

 If the answer was light-headed, the next question I ask: “Do you feel that way all of the time or just when you sit up or stand up?”

 If the answer is upon sitting or standing, the patient may be experiencing orthostatic hypotension, or a drop in blood pressure with position change. Comparison of blood pressure while lying down, sitting up and standing will determine if the patient is experiencing a drop in blood pressure. If they are, this should be reported to a nurse or physician. You should encourage patients who experience orthostatic hypotension to stay hydrated and change positions slowly, allowing time for their blood pressure to regulate before starting to walk. 

If the patient is experiencing dizziness unrelated to position change, there could be a number of other causes that the patient should discuss with a medical professional, for example low blood sugar, dizziness caused by medication, hormonal imbalances or anemia. Patients can even develop symptoms of dizziness related to allergies or sinus infections.

Sudden onset of dizziness can be a sign of a severe medical event such as heart attack, stroke or severe infection and should be considered a medical emergency requiring emergency medical care.

One consideration for treating older adults is that they may not tell you that they are having problems with dizziness or they may not realize that it is causing them to be afraid of falling. This is why it is important to discuss with your patients how much they were up and moving before entering physical therapy. I can think of several occasions when I met a patient for the first time who stated that they have not been walking very much because they were afraid of falling and upon further questioning, I found that dizziness was the root of the problem. And just by asking a few more questions we were able to develop a plan to resolve their dizziness and get them back on their feet.