Distracted Walking, Dizziness & Vertigo: Part 1

Basic Research on Dizziness & Vertigo

The terms dizziness and vertigo cover a variety of symptoms regarding disorders of orientation to the environment and motion perception, such as the illusion of spinning (classical rotatory vertigo) or the feeling of unsteadiness, which can affect a person's ability to achieve a stable gaze, posture, and gait (Jonsson et al, 2004). According to Barin and Dodson (2011),  the prevalence of these symptoms reaches 30% beyond 60 years of age, and rises to 50% beyond 85 years (Jonnsson et al, 2004).

The sole presence of dizziness in the elderly is a strong predictor of falls (Agrawal et al, 2009), and, according to Ekvall and Magnusson (2013), the presence of abnormal balance tests increases the risk of hip and wrist fractures. Injuries related to falls lead to mobility restriction and loss of independence, and increase the fear of falling, which also predicts subsequent falls (Barin and Dodson, 2011). Falls are the leading cause of accidental death in persons older than 65 years (Kannus et al, 1999), while dizziness is one of the strongest contributors to disability after age 65 (Meuller et al, 2014).

Each year, 33 percent of adults over 65 who live at home fall. Between 12 and 67 percent of these adults who fracture a hip due to their fall die within one year (Kannus et al, 1999). As a result, major scientific efforts are devoted to determining the causes of falling in older adults in an attempt to reduce this significant health hazard. 

Dizziness is the 3rd leading cause of visits to the doctor's office, behind the common cold and back pain.

Causes & Effects

In the mature adult population, a variety of diseases affects the systems responsible for balance, including cataracts, glaucoma, diabetic retinopathy, and macular degeneration, which all affect vision; diabetic peripheral neuropathy, which affects position sense in the feet and legs; and degeneration of the vestibular system. Balance is also dependent on good muscle strength and joint mobility. A sedentary lifestyle or diseases of bones and muscles can compromise strength and mobility. This can lead to obstructed falls (e.g tripping on uneven surfaces such as throw rugs, falls on wet surfaces, falls on stairs or curbs). Simple and inexpensive solutions to these obstructed falls include:

Prevention Strategies

• Set up the home for falls prevention: install grab gars, grip surfaces in bathroom, shower seats, elevated toilet seats, night lights.

• Act on your own behalf, or help a family member prevent falls: widen your base of support when standing, placing feet about 12 inches apart, use appropriate assistive devices (reachers, canes, walker/rolling walker), plan your trip - whether to the kitchen or to the market - carefully (called 'motor planning').

Medication May Worsen Conditions; Try Exercise First

There are many causes of dizziness, most being easily treatable with simple exercises. Although 70% of patients do not receive a specific diagnosis, greater than 90% are prescribed medication (Meclizine) for treatment. The medication may be effective in the short term, but acts to suppress the body's vestibular system (inner ear) and may make the condition worse over time. Some  vestibular exercises and balance activities may at first cause an increase in symptoms, as the body and brain attempt to accommodate to new movement patterns. With time and consistency, the symptoms abate. Many times, vestibular rehabilitation is so successful that no other treatment is required.

Facts & Costs About Balance and Dizziness

One out of three older adults (those aged 65 or older) falls each year but fewer than half of those talk to their healthcare providers about it.

Among older adults, falls are the leading cause of both fatal and nonfatal injuries.

In 2010, 2.3 million nonfatal fall injuries among older adults were treated in emergency departments and more than 662,000 of these patients were hospitalized.

In 2010, the direct medical cost of falls was $30 billion.

If you have questions regarding balance, vertigo, dizziness and falls, or would like to make an appointment for an evaluation, please contact us.

References:

Agrawal Y, Ward BK, Minor LB. Vestibular dysfunction: prevalence, impact and need for targeted treatment. J Vestib Res (2013) 23:113-7.

Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the national health and nutrition examination survey, 2001-2004. Arch Intern Med (2009) 169:938-44.

Barin K, Dodson EE. Dizziness in the elderly. Otolaryngol Clin North Am (2011) 44:437-54.

Batuecas-Caletrio A, Trinidad-Ruiz G, Zschaeck C, Del Pozo De Dios JC, De Toro Gil L, Martin-Sanchez V, et al. Benign paroxysmal positional vertigo in the elderly. Gerontology (2013) 59:408-12.

Ekvall Hansson E, Magnusson M. Vestibular asymmetry predicts falls among elderly patients with multi-sensory dizziness. BMC Geriatr (2013) 13:77.

Jonsson R, Sixt E, Landahl S, Rosenhall U. Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res (2004) 14:47-52.

Kannus P, Parkkari J, Koskinen S, Niemi S, Palvanen M, Jarvinen M, et al. Fall-induced injuries and deaths among older adults. JAMA (1999) 281:1895-9.

Mueller M, Strobl R, Jahn K, Linkohr B, Peters A, Grill E. Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study. Eur J Public Health (2014) 24:802-7.