The Aging Vestibular System: Dizziness and Imbalance in the Elderly

Aging in vestibular structures with loss of hair cells in the inner ear starts early in life, but vestibular function usually remains relatively unimpaired up to advanced ages. However, dizziness and imbalance are common in the elderly and have substantial impact on the quality of life. Dizziness interferes with the everyday activities of 30% of persons over age 70. As causes can be multiple, including vestibular and non-vestibular components, it is crucial to detect the factors leading to dizziness and imbalance to maintain mobility and avoid secondary complications like falls and anxiety. The more common causes of dizziness and imbalance in old age are sensory deficits, such as bilateral vestibular hypofunction, polyneuropathy, and impaired visual acuity; benign paroxysmal positional vertigo; and central disorders such as cerebellar ataxia and normal-pressure hydrocephalus. Further relevant factors include sedative or antihypertensive medication, loss of muscle mass (sarcopenia), and the fear of falling. Many elderly persons have multiple risk factors at the same time. Treatable components include benign paroxysmal positional vertigo that can be effectively treated with specific physical maneuvers, sedating drugs that can be reduced in many cases, and sarcopenia that can be treated with physical training. If a specific cause for dizziness and imbalance can be identified, treatment is often successful even in advanced age. The common causes can be revealed by systematic clinical examination and selective laboratory testing.