{"id":6143,"date":"2020-07-08T09:04:19","date_gmt":"2020-07-08T13:04:19","guid":{"rendered":"http:\/\/www.silvercentury.org\/?p=6143"},"modified":"2020-08-15T06:51:59","modified_gmt":"2020-08-15T10:51:59","slug":"older-and-wiser-but-dizzier","status":"publish","type":"post","link":"http:\/\/78.142.243.82\/~silvercentury\/2020\/07\/older-and-wiser-but-dizzier\/","title":{"rendered":"Older and Wiser\u2014but Dizzier"},"content":{"rendered":"

Carol Kuhlman vividly remembers a weekend trip with friends about two years ago\u2014because that\u2019s when she started feeling dizzy. The lightheaded, unsteady sensation came on gradually and quickly got worse. <\/span><\/p>\n

\u201cIt was very uncomfortable,\u201d said Kuhlman, 66. \u201cI had to hold onto things just to keep from falling. By Monday I was so dizzy, I couldn\u2019t go to work.\u201d<\/span><\/p>\n

Her physician diagnosed her with vertigo, noticing her rapid eye movements, recommended some exercises and prescribed meclizine, which didn\u2019t prove a practical solution. <\/span><\/p>\n

\u201cI took one tablet in the middle of the day and immediately slept for five hours,\u201d she said. <\/span><\/p>\n

The doctor wrote a note to excuse Kuhlman from work\u2014for just two days. She was still dizzy when she went back. Her colleagues immediately noticed something wasn\u2019t right. <\/span>\u201cI was very unsteady on my feet and weaving all over the place,\u201d she said.<\/span> <\/span><\/p>\n

Many times, dizziness is caused by something benign, but it\u2019s still emotionally and psychologically devastating. <\/b><\/p><\/blockquote>\n

Kuhlman\u2019s struggle wasn\u2019t an atypical one for older adults. Dizziness can affect anyone, but older people are more prone\u2014about 70 percent of adults over 65 have suffered from it in some form. And compared to younger people, dizziness in older adults tends to be more persistent, have more causes and be more incapacitating. <\/span><\/p>\n

\u201cWe see patients with dizziness very frequently, and we take it very seriously,\u201d said Anupama Gangavati, MD, an assistant professor in internal medicine in the division of geriatric medicine at UT Southwestern Medical Center in Dallas. <\/span><\/p>\n

A patient\u2019s experience of dizziness may come in a variety of forms: a feeling of lightheadedness or imbalance; a sensation of blacking out; or vertigo, the perception that the patient\u2014or the surrounding environment\u2014is spinning, tilting or moving. <\/span><\/p>\n

Several studies show that older people with a history of dizziness are at higher risk of falling, which is a leading cause of hospitalization and accidental death among those over age 65.<\/span><\/p>\n

While many causes of dizziness turn out to be benign, the effects can be emotionally and psychologically devastating. Dizziness is disorienting and unnerving. Sudden bouts are frightening; chronic cases can be debilitating. <\/span><\/p>\n

\u201cIt\u2019s a quality of life issue,\u201d said Gangavati. \u201cDizziness can lead to a lot of psychological distress if you\u2019re not able to control it. Patients should not let it go just because a physician has not addressed it successfully on the first try.\u201d  <\/span><\/p>\n

What Causes Dizziness?<\/b><\/p>\n

Accurate diagnosis can be a challenge. Dizziness can stem from a range of issues, including problems affecting the inner ear, brain, eyes, nervous system, vascular system or heart, all of which are subject to aging-related changes, according to Kathleen Stross, PT, a neurological and vestibular therapist.<\/span><\/p>\n

Many older adults take multiple medications; dizziness may be a side effect of one or the result of an interaction between drugs. Neurological conditions like Parkinson\u2019s can cause dizziness. Even health issues that might seem unrelated\u2014such as neuropathy (numbness or loss of feeling) in the feet\u2014can cause a patient to feel unbalanced and dizzy. Stress, depression or a lack of exercise may also contribute, as can dehydration or hot weather conditions. <\/span><\/p>\n

Among older people, one of the most common causes of dizziness is dysfunction of the peripheral vestibular system\u2014the inner ear and its pathways to the brain. This controls a person\u2019s balance and spatial perception. Neurologists call the vestibular system \u201cthe sixth sense\u201d and, just like other sensory functions, it changes as people age. <\/span><\/p>\n

\u201cAs we age, just as our vision changes and our hearing may be affected, the vestibular system ages as well and may not function as well as it did when we were younger,\u201d said Stross.<\/span><\/p>\n

Patients can help their medical providers to diagnose the cause more accurately by giving a clear description of their dizziness. Stross gives new patients a questionnaire to help pinpoint their experience\u2014what it feels like, how often it occurs and what, if anything, seems to trigger it. <\/span><\/p>\n

\u201cThe way people describe it can really vary, so I ask patients to tell me how they feel without using the word \u2018dizzy,\u2019\u201d said Stross. \u201cFor some, it\u2019s a feeling of being lightheaded or off-balance. Some describe it as feeling \u2018heavy headed\u2019 or a sense of floating or pressure. Others say they feel as if they\u2019re spinning or moving.\u201d  <\/span><\/p>\n

Steve Lavine, 65, of Plano, TX, began experiencing dizzy spells when standing up from a chair. They got progressively worse, to the point where he felt he might black out. Lavine checked his blood pressure and found it was low, almost dangerously so. After consulting with his physician, Lavine stopped the blood pressure medication he had been taking for more than six months with no problems. Lavine had since lost 15 pounds through diet and exercise. The medication was now overcorrecting and making his blood pressure too low, causing the dizzy spells. When he stopped the medicine, the problem disappeared in a few days.<\/span><\/p>\n

A thorough medication review is absolutely important.<\/b><\/p>\n

\u2014 Anupama Gangavati, MD<\/b><\/p><\/blockquote>\n

When a patient complains of dizziness, one of the first things Gangavati checks is the person\u2019s list of medications. Blood pressure medications are common culprits, as are antidepressants, beta blockers, prostate medications and diuretics.   <\/span><\/p>\n

\u201cMedications are one of the most common contributors of lightheadedness or dizziness,\u201d she said. \u201cA thorough medication review is absolutely important.\u201d <\/span><\/p>\n

Gangavati also performs an exam, reviews the patient\u2019s medical history and asks about triggers\u2014when the dizziness occurs and what seems to be causing it. <\/span><\/p>\n

Beyond drug side effects, Gangavati said she sees three common causes of dizziness among her older adult patients: benign paroxysmal position vertigo (BPPV), orthostatic hypotension and postprandial hypotension. <\/span><\/p>\n

BPPV occurs when tiny calcium particles (canaliths) clump up in canals of the inner ear, interfering with normal perception about head and body movements relative to gravity. Doctors diagnose the condition by observing patients\u2019 eyes while they\u2019re moving their heads. Patients with BPPV exhibit rapid, uncontrollable eye movements. The symptoms may be severe, making the patient feel as if the room is spinning, and may lead to nausea and vomiting. <\/span><\/p>\n

\u201cBPPV tends to occur in episodic bouts of a few hours,\u201d Gangavati said. \u201cIt\u2019s triggered by head movement, and if you stop moving your head and keep it in one position, it subsides or goes away.\u201d <\/span><\/p>\n

Orthostatic hypotension is a bout of dizziness or lightheadedness due to a lack of blood supply to the brain, typically triggered when a person stands from a sitting or lying position. Postprandial hypotension occurs when patients feel dizzy or faint after eating a meal, because their blood supply is geared to the stomach to digest the meal.<\/span><\/p>\n

Trial and Error<\/b><\/p>\n

Imani Calicutt, 65, of Dallas, sometimes experiences bouts of dizziness, and her doctor\u2019s not sure why.<\/span><\/p>\n

\u201cLately, it\u2019s been constant,\u201d she said. \u201cIt\u2019s really limiting me because I can\u2019t go very far without having to sit down.\u201d<\/span><\/p>\n

She\u2019s working with her doctor (now via telemedicine due to the COVID-19 crisis) to determine the cause. Because Calicutt takes an array of medications for arthritis, diabetes, chronic pain and kidney disease, she\u2019s expecting it may take some trial-and-error to find the cause.  <\/span><\/p>\n

That\u2019s not uncommon, Stross said. <\/span><\/p>\n

\u201cIn our experience, patients usually need to see three physicians before they get an answer,\u201d said Stross. Because dizziness could relate to any number of areas of the body, finding the right specialist isn\u2019t easy. <\/span><\/p>\n

After a visit to a primary care physician, the patient\u2019s next step might be an appointment with an ENT (ear-nose-throat) specialist or a neurologist, or possibly a cardiologist (if vascular issues are suspected) or hematologist (if anemia is suspected). <\/span><\/p>\n

Brief moments of lightheadedness are probably not serious but do mention them to your doctor.<\/b><\/p><\/blockquote>\n

To treat dizziness, a physician may prescribe medications or dietary and behavioral modifications. That can include basic steps like ensuring the patient is drinking enough fluids and getting enough rest and exercise. <\/span><\/p>\n

For problems relating to the inner ear, including BPPV, vestibular rehabilitation therapy can be effective. Vestibular therapy ranges from simple exercises (a well-known one is the Epley maneuver, which involves positioning the head to help dislodge the tiny particles that cause BPPV) to physical therapy that helps the patient learn to compensate for imbalance and maintain physical activity. Vestibular therapy, when indicated, may provide immediate relief, or it may take some time to see results.<\/span><\/p>\n

Gangavati added that many older people will experience brief moments of lightheadedness that likely don\u2019t signal any serious problem. But she recommends at least mentioning it on the next visit to the doctor. \u201cI think any dizziness should be discussed with your physician.\u201d <\/span><\/p>\n

If acute dizziness occurs and is accompanied by other symptoms\u2014like chest pain, difficulty walking or slurred speech\u2014it could be a medical emergency, like a heart attack or stroke. In that case, Gangavati advises, head to the emergency room.  <\/span><\/p>\n

Chronic Dizziness<\/b><\/p>\n

Twelve years ago, as he walked out of the hospital after finishing his rounds, Tom Davis began to feel dizzy.  <\/span>
\n<\/span><\/p>\n

\u201cI\u2019ve been dizzy ever since,\u201d said Davis, 58, a physician in St. Louis, MO. Over the years, specialists have come up with different diagnoses: vestibular neuronitis, vestibulitis and Meniere\u2019s disease, among others. None of the prescribed treatments fixed the problem permanently. Vestibular therapy made it worse. He considered surgery, which would destroy the nerve in the inner ear, but that would leave him deaf in one ear and offered no guarantees. At this point, instead of searching for a diagnosis, he\u2019s focused on managing the symptoms as best he can. <\/span><\/p>\n

\u201cIt really doesn\u2019t matter what\u2019s causing it, because there\u2019s no way to fix it,\u201d he said. \u201cYou just have to work your way around that reality.\u201d Regular exercise keeps him strong and helps reduce the risk of falls. On bad days, he takes a low-dose sedative and rests.<\/span><\/p>\n

Unfortunately, like Davis, some people may have to contend with dizziness as a chronic or recurring issue. He says getting social support is important, especially for older people who might be tempted to isolate or become sedentary, for fear of falls. <\/span><\/p>\n

\u201cIf you have chronic dizziness, you\u2019re not alone,\u201d he said. \u201cThere are many groups on Facebook where you can get support from others.\u201d <\/span><\/p>\n

Patients with chronic dizziness can also find helpful information and links to providers on the website for the <\/span>Vestibular Disorders Association<\/span><\/a>. Several other organizations offer <\/span>support groups and other resources<\/span><\/a>.   <\/span><\/p>\n

Carol Kuhlman has been more fortunate. She did find some relief. She returned to work, still dizzy, a few days after her symptoms first appeared. She\u2019s an administrative assistant at a medical school and, as luck would have it, an expert on vestibular disorders was visiting her department that day. <\/span><\/p>\n

Coworkers arranged for her to see the specialist, who diagnosed acute peripheral vestibulopathy (inflammation of the inner ear). He prescribed vestibular therapy, which helped reduce the dizziness and restored her sense of balance. Kuhlman still has flare-ups from time to time, but she\u2019s found a way to manage them. Exercise and stress management seem to help.<\/span><\/p>\n

\u201cWhen it recurs, I go back to the balancing exercises, which help,\u201d she said. \u201cAnd when I have a flare-up, I just have to push through.\u201d <\/span><\/p>\n

 <\/p>\n","protected":false},"excerpt":{"rendered":"

Carol Kuhlman vividly remembers a weekend trip with friends about two years ago\u2014because that\u2019s when she started feeling dizzy. The lightheaded, unsteady sensation came on gradually and quickly got worse.  \u201cIt was very uncomfortable,\u201d said Kuhlman, 66. \u201cI had to…<\/span><\/p>\n

Read more Older and Wiser\u2014but Dizzier<\/span> ›<\/span><\/a><\/div>\n

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