The prevalence of dysequilibrium and related disorders in older persons

Dysequilibrium disorders such as dizziness, balance and gait changes, and falls are among the most common yet poorly understood medical problems for older persons. A recent analysis of data about people aged 65 and older indicates that dysequilibrium is one of most common diagnoses in short-stay hospitalizations, and it accounts for an average of 4.3 days of medical care. Older people without overt disease of any type tend to perform more poorly on balance tests than do younger people. Gait deficits in many older people are associated with considerable functional impairments. Deficits in postural control are associated with an increased risk of falling. Geriatric dysequilibrium disorders can be caused by one or more factors--vestibular, vascular, visual, neuromuscular, pharmacologic--each of which must be considered to understand and appropriately treat the dysequilibrium. The accurate identification of the cause of dysequilibrium must involve the testing of multiple, interacting systems. The literature suggests that often no clear cause for an older person's dysequilibrium can be found, and indicates the possible existence of presently unappreciated etiologic factors. Progress in understanding these problems probably has been stymied by the fact that only a small, select subgroup of older patients is referred to specialists in otolaryngology. Quite probably, considerable progress on the understanding of the cause, diagnosis, and treatment of geriatric dysequilibria would result from more extensive research collaboration between otorhinolaryngologists, geriatricians, epidemiologists, and other specialists.