Vertigo in the Elderly: A Systematic Literature Review

Abstract

Background: Dizziness and vertigo are among the most prevalent complaints in the elderly and have a major negative influence on (i) the perception of the quality of life; and (ii) the risk of falling. Due to population aging, particularly in wealthy nations, vertigo represents a growing issue and a serious public health concern. In order to approach the patient correctly and to offer the best treatment options, it is mandatory to identify vertigo’s underlying causes. The aim of this paper was to identify the different etiologies of vertigo and possibly their frequency in the elderly population, by reviewing the scientific literature of the last decade (2012–2022). Methods: A systematic review was performed according to PRISMA guidelines, searching the Medline database from January 2012 through to December 2022. The search identified 1025 candidate papers, but after the application of specific selection criteria, only five were considered for further analysis. Results: A total of 2148 elderly patients (60–90 y old) presenting with vertigo were reported in the selected papers. A total of 3404 conditions were identified as the cause of vertiginous symptoms, (some patients presented multiple etiologies). All major diagnoses were categorized into different subgroups: the most common origin of vertigo was represented by audio-vestibular disorders (28.4%), followed by cardiovascular (20.4%) and neurological diseases (15.1%). Furthermore, 9.1% of patients were diagnosed with psychiatric conditions, whilst ophthalmologic and musculoskeletal disorders accounted for 7.5% and 6.3% of the cases respectively. Medication adverse effects and metabolic-related diseases were also considered among the causes. For 3.4% of cases the etiology remains unclear. Conclusions: Audio-vestibular disorders represent the most frequent cause of vertigo in the elderly. The etiologies affecting the vertigo patient must be defined in order to identify potential life-threatening conditions, such as cardiovascular and neurological disorders, which according to the data of this review constitute the second and third common causes of vertigo. A multidisciplinary strategy, involving different specialists (such as ENTs, Neurologists, Cardiologists, Geriatricians) is recommended for the correct assessment of these disorders.

Surveying physical therapists' understanding of benign paroxysmal positional vertigo

“…While “room spinning” dizziness is considered the hallmark symptom of posterior canal BPPV, others have reported persons with BPPV endorsing light-headedness, dizziness, sinking, floating, nausea, or feeling off balance ( 1 , 23 , 24 ). BPPV is a vestibular abnormality and can result in an increased risk of falling and impairments in activities of daily living ( 3 – 5 ). Adults over 40 with vestibular dysfunction have a 12-fold increase in the odds of falling ( 25 ).…”

“…Transient subjective dizziness or vertigo with nystagmus in the plane of the involved semicircular canals from positional testing are diagnostic of definite BPPV (2). If left untreated, BPPV is correlated with a decrease in activities of daily living scores, an increased rate of falling, and increased rates of depression (3)(4)(5)(6). According to the American Academy of Otolaryngology-Head and Neck Surgery (AAHN) 2018 Clinical Practice Guidelines and recommendations by the American Academy of Neurology, positional tests are the gold standard for diagnosing BPPV, with strong recommendations for treating BPPV with canalith repositioning maneuvers (3,7).…”

Aging of the vestibular system and its relationship to dementia

“…It is well established that vestibular dysfunction, contributing to dizziness and vertigo, increases with age [18,19,20 & ,21,…”

“…It is well established that vestibular dysfunction, contributing to dizziness and vertigo, increases with age [18,19,20 ▪ ,21,22 ▪ ] for reviews]. Specific estimates vary according to country and definitions but Agrawal et al [23] estimated that 35% of US adults aged 40 and older exhibited balance dysfunction, rising to 85% in people aged 80 and over.…”

Investigation of hearing loss in elderly vertigo and dizziness patients in the past 10 years

“…Previous studies indicate that vertigo is prevalent in the elderly population, with estimates of incidence ranging from 20 to 58% (Lasisi and Gureje, 2014 ; Lindell et al, 2021 ; Fancello et al, 2023 ). The pathogenesis of vertigo is multifactorial and primarily characterized by illusions of rotational motion, often accompanied by symptoms such as nystagmus, postural imbalance, falls, and neurovegetative effects (Roque Reis et al, 2016 ; Du et al, 2022 ).…”