Chronic dizziness in older persons.

DS, an 85year-old woman, complains of intermittent dizziness, and three falls over 6 months. She lives with her son, who witnessed the falls, which occurred in the home. There has been no loss of consciousness or serious injury. She has hypertension, coronary artery disease, mild bilateral cataracts, chronic backache, diabetes mellitus, impaired hearing, and mild cognitive impairment. She has been using a cane for 7-8 months. Mrs. S says sometimes she feels woozy and light-headed, other times she feels the room is spinning. The episodes usually occur when she tries to stand from sitting or lying down. She denies nausea or vomiting. Medications include gilipizide xl 5 mg daily, metformin 500 mg twice daily, baby aspirin, metoprolol 12.5 mg. twice a day, nifedipine XL 60 mg. daily, ranitidine 150 mg. twice daily, acetaminophen prn, multivitamin tablet, and calcium plus vitamin D twice a day. Dizziness is the subjective sensation of instability of posture or of illusory motion. A nonspecific term, it includes lightheadedness, vertigo, dysequilibrium, spinning, giddiness, faintness, and other sensations. Dizziness is often classified, as acute (present for less than one or two months), or chronic (present for more than one or two months). The causes of acute dizziness are usually similar for patients of all ages. Therefore, this discussion will be limited to chronic dizziness. Dizziness is one of the most common presenting complaints in primary care practice for persons aged 65 years and older. The overall prevalence ranges from four to 30%, and it is more common in women. The complaint increases by 10% for every 5 years of increasing age. Chronic dizziness has been associated with increased risk for falls, increased fear of falling, orthostatic hypotension, syncope, stroke, and disability, and has a negative effect on quality of life among older persons, as well as worsening of depressive symptoms. ,5