Evaluation and management of dizziness in the older patient

The increased prevalence of dizziness with advancing age is the result of specific disease processes superimposed on normal aging physiology. The first step in evaluating dizziness in older persons is a careful clinical history, focusing on the type, temporal pattern, onset, associated symptoms, and the patient's overall physical health. Common dizziness problems in this age group are postural dizziness without postural hypotension, positional vertigo, cerebrovascular disease, a variety of acute and recurrent labyrinthine problems, neck problems, physical deconditioning, and medications. Often, multiple problems coexist, and secondary psychologic disability results. Treatment should aim at identifying and managing remediable problems.