Seniors and Vertigo: A Complete Guide

Edited by Dr. Kimberly Langdon, M.D., Board Certified Physician

While vertigo isn't life-threatening by itself, it's a major predictor of falls for seniors. According to the Centers for Disease Control (CDC), every 12 seconds, an older American is admitted to the emergency department for a fall. Every day, 74 of those will die from a fall. That's why treating vertigo effectively is such a critical issue for keeping seniors safe and healthy. This guide covers everything you need to know. Learn what causes vertigo, how it's treated, and what you can do to ensure your safety.

Vertigo and Dizziness - Aren't They the Same Thing?

Most people assume that vertigo is the same as dizziness. Yet, there is a difference. Understanding this nuance can help you and your doctor assess the underlying cause and resolve the symptoms more quickly.

What does vertigo feel like? Vertigo is often described as a sensation of spinning. The room is whirling around you. You may feel like someone is shaking your head up or down vigorously or that your body is being pulled in one direction.

Dizziness, on the other hand, is less extreme. You may feel light headed, disoriented, and unsteady on your feet. The distinction is important because dizziness without the specific vertigo symptoms means your doctor needs to explore a number of other factors, such as blood pressure, head injury, stroke, dehydration, or medication side effects. Dizziness is a side effect for many drugs, particularly those for illnesses affecting seniors, and so doctors must be careful to consider all possibilities.

Staying Safe When You Have Vertigo

Here are a few simple steps you can take to keep yourself safe during a bout of vertigo or dizziness. It is very important to take care of yourself when you are experiencing vertigo because it is one of the leading causes of dangerous falls in seniors.

What Causes Vertigo?

Most cases of vertigo are a symptom of an inner ear disturbance, referred to as peripheral vertigo. In older adults, the most common cause is degeneration of the vestibular system of the inner ear. There are five disorders that fall into this category.

Benign paroxysmal positional vertigo (BPPV)
Vestibular neuritis
Labyrinthitis
Cholesteatoma
Meniere's disease

BPPV is caused by calcium carbonate crystals that loosen and fall into one of the canals of the inner ear. As you move your head, the crystals move around inside the canal. This irritates the nerve endings, which causes the sensation of vertigo.

Vestibular neuritis occurs when vestibular branch of the vestibulocochlear nerve becomes inflamed and swollen, often due to a viral infection. The vestibulocochlear nerve sends balance information from the inner ear to the brain. The swelling interferes with this transfer of information, resulting in vertigo.

Labyrinthitis is similar to vestibular neuritis, but involves swelling on both branches of the vestibulocochlear nerve. In this disorder, since the cochlear branch is also affected, you may also experience hearing loss and ringing in the ears (tinnitus).

Cholesteatoma is a skin growth that develops in the middle part of your ear, behind the eardrum. It often develops in response to several middle ear infections, although it can be a birth defect. As the cyst grows, the potential for more symptoms rises. This includes vertigo but also partial facial muscle paralysis and hearing loss.

Meniere's disease isn't as well understood by the medical community. It could be caused by a number of factors. A popular theory is that abnormal changes in the amount of fluid (or endolymph) in the inner ear (or labyrinth) affect the tiny receptors for equilibrium and hearing. The changing pressure causes vertigo, as well as hearing loss, ringing in the ears and ear fullness.

Aside from inner ear disorders, vertigo can also be caused by disruptions to the sensory nerve pathways. This is referred to as central vertigo and often has a precipitating event or diagnosis such as head trauma, multiple sclerosis, migraines, brain tumors or strokes. If you're seeing a new doctor or specialist, it's important that he/she has your full medical history.

How can I prepare for my doctor's appointment?

Many seniors have comorbid conditions and medications that can complicate a diagnosis. As with any doctor visit, it's important to share as much detail as possible - whether or not it seems related. Make sure your doctor has an accurate list of all medications, vitamins and supplements.

Before your appointment, write down answers to these questions to make sure you don't forget any important details.

How often do you experience vertigo?
How long do vertigo episodes last?
Does the vertigo seem to be on one side or both?
Do you have nausea or vomiting in conjunction with the vertigo?
Does anything seem to trigger vertigo, like types of movement or an activity?
Have you had any recent blows to your head, even minor?
Do you notice new vision problems?
Do you have headaches?
Do you have ear ringing?
Do you have ear fullness?
Has your hearing diminished?

You should also have a list of follow up questions for your doctor such as:

What do you think is the cause of my vertigo symptoms?
Do I need to see a specialist?
How soon will treatment ease my symptoms?
Do I need to restrict any activities?
Am I at risk for vertigo to return?

How is vertigo diagnosed?

There are several ways that doctors assess whether you are experiencing vertigo. Experienced physicians will adapt these tests for their senior patients. They are inducing vertigo symptoms by moving your head and body in specific positions that may not be comfortable for older individuals with other health issues. Be sure to speak up if you have any concerns before or during the tests. Here are four of the most common assessments.

Nystagmus Testing or Dix-Hallpike Maneuver

You will sit on an exam table with legs outstretched. Your doctor turns your head 45 degrees, then you lie back so your head is slightly over the edge. After sitting up, the doctor will check if you're exhibiting certain eye movements and if you experienced the vertigo symptoms.

Head Impulse Test

Your doctor will hold your head in both hands, asking you to focus on his/her nose. Your head is moved quickly to one side, about 10-15 degrees. This is repeated on the opposite side. The doctor will assess your eye movement and if you experienced vertigo during the exam.

Romberg's Test

You'll be asked to stand in one place with arms and feet together with your eyes closed. If you sway to one side, this typically indicates which side of the inner ear is affected.

Unterberger's Test

Similar to the Romberg's test, you'll be asked to stand with your eyes closed. However, in this test, you'll be asked to march in place. The doctor is also looking to see if you tilt to one side in order to see which inner ear (if any) is affected.

If you visit the ER or an urgent care center with an acute, long-lasting vertigo attack, the doctor will likely run a CT scan or MRI to rule out a vascular event or a transient ischemic attack (mini-stroke) in addition to the above tests. Your age and medical history will determine the most appropriate course of action.

When Vertigo is an Emergency

It's important to note that if vertigo lasts more than a few minutes, you need to be assessed immediately, rather than waiting for a regular physician visit. In addition, if you have vertigo in combination with one or more of these symptoms, you should see a doctor right away. Seniors in particular must take action as soon as these symptoms become apparent.

Hearing loss
Fever
Loss of consciousness
Double vision
Loss of vision
Trouble speaking
Leg or arm weakness
Falling or difficulty walking
Numbness or tingling
Facial paralysis

Traditional Vertigo Treatments

The method of treatment will depend on the cause of your vertigo symptoms and your physical capabilities. Your doctor will need to consider other conditions that could affect your balance such as peripheral neuropathy, orthopedic issues and sensory loss. These are all prevalent issues among seniors, so a tailored approach is necessary.

Since BPPV is the most common and treatable type of vertigo, we've outlined treatment options for this disorder in particular.

Canalith Repositioning Procedure (CRP)

This procedure is a few simple head maneuvers, performed by your doctor. It is often very effective after one to two treatments for most patients with vertigo. However, it is not always appropriate for seniors due to medical conditions such as a neck or back condition, a detached retina, or vascular problems. Some doctors and specialists have adapted CRP to be more comfortable for seniors, such as changing the position of the examination table.

Home Balancing Exercises

There are two simple exercises that you can do at home to resolve the issue - Epley Maneuver and Brandt-Daroff Exercises. Your doctor will likely demonstrate these and provide the steps with photos. There are also numerous instructional videos on YouTube. It's important to do these in a safe environment since these exercises will induce vertigo. Seniors in particular may also be referred to a physical therapist for assistance with the exercises.

You can do the Epley Maneuver three times before bed each night, until you've gone 24 hours without vertigo symptoms. You'll perform on your left side, then your right.

Sit at the bottom of your bed.
Position a pillow so when you lie down, it supports your shoulders, not your head.
Turn your head 45 degrees to the left.
Quickly lie down, with your head on the bed (still at the 45-degree angle). The pillow should be under your shoulders. Wait 30 seconds for vertigo to stop.
Turn your head 90 degrees to the right without raising it. Wait 30 seconds.
Turn your head (and body) on its side to the right. You'll be looking at the floor. Wait 30 seconds.
Slowly sit up and stay on the bed for a few minutes.
Reverse these instructions to the right.

You can perform the Brandt-Daroff exercises three to five times per session. Doctors recommend three sessions a day for up to two weeks. Or, if you have no vertigo symptoms for two days.

Sit upright on your bed, with feet on the ground.
Turn your head in a 45-degree angle to the left.
Tip over into a lying position on one side. Your nose should be pointed upward.
Stay in this position for about 30 seconds (or longer as needed).
Lift yourself back to the seated position.
Reverse these instructions to the right.

Medications

Drugs for BPPV are typically used for relieving symptoms rather than resolving the vertigo. Most of these medications can cause drowsiness. They should not be taken before driving or working. For seniors with other prescriptions, it is especially important to make sure there are no drug interactions.

According to WebMD, commonly prescribed medications for vertigo include:

meclizine hydrochloride (Antivert)
scopolamine transdermal patch (Transderm-Scop)
promethazine hydrochloride (Phenergan)
metoclopramie (Reglan)
odansetron (Zofran)
diazepam (Valium)
lorazepan (Ativan)
clonazepam (Klonopin)
Prednisone

Some over-the-counter antihistamines may also be recommended such as diphenhydramine (Benadryl) and dimenhydrinate (Dramamine).

Alternative Treatments for Vertigo

While many people find these treatments effective, you should always consult with your doctor to make sure there are no contraindications with your medications or home exercises. If approved, these are gentle, non-invasive treatment options that may appeal to seniors with limited ability to do the body or head movements prescribed earlier. They can also be used as preventative measures since vertigo can recur.

Acupressure

Acupressure is similar in principle to acupuncture. It is based on the concept of life energy which flows through meridians in the body. Acupressure therapy stimulates a specific set of pressure points located on the body, thereby relieving vertigo symptoms. The pressure stimulates, disperses and balances the flow or energy.

Ginkgo Biloba

The International Journal of Otolaryngology found Ginkgo Biloba just as effective as the medication betahistine, which is commonly prescribed for balance disorders. However, it may need to be taken for two to four months to see an effect.

Ginger Root

Drinking ginger tea can help relieve dizziness and nausea associated with vertigo symptoms. In fact, the Journal of Acupuncture and Tuina Science found that it can reduce the effects of vertigo better than manual repositioning, such as the Epley maneuver, alone.

Essential Oils

Essential oils can be diluted in a carrier oil before being applied topically or inhaled through an infuser. You may need to experiment to find the one that works best for your symptoms. Commonly suggested oils include lavender, ginger, clary sage, basil, rosemary and frankincense. Please note that people with respiratory illnesses may not tolerate essential oils.

What to Expect After Vertigo Treatment

After your physical treatment (either after an office maneuver or home exercises), avoid head positions that might trigger BPPV such as:

Lying flat on your back (use two pillows instead)
Sleeping on the side with vertigo (if it's one-sided)
Any exercise that has your head in a far forward position
Sudden head movements

It's especially important to be aware of situations outside the home that could trigger BPPV such as visiting the dentist, hair salon or massage, where your body or head may be tilted. Seniors in particular should report their vertigo tendencies to these providers so they can be prepared in case you begin to fall.

After one week, test yourself in a position that normally causes vertigo, but be sure to do so in a safe environment. If your symptoms do not resolve within one week, speak to your doctor about follow-up or referral to a specialist.

Staying Safe During Vertigo

Vertigo often recurs, so it's important to know how to stay safe during an episode. According to AmericanHearing.org, about 30% of patients have a recurrence in the first year after treatment, and by five years, about half of all patients have a recurrence. Knowing this, you should always be prepared. These precautions are especially important for seniors to prevent serious injury or death from falls.

Be vigilant about the return of symptoms so you can resume home exercises or follow up with your doctor
Always stay hydrated, as dehydration can trigger a return of symptoms
Sit down as soon as you feel dizzy
Walk with a cane or walker if you have additional balance issues
In the morning or after a nap, sit on your bed and assess yourself before standing up
Purchase an object "grabber" rather than tilting your head upwards to reach something
If you know a particular movement can trigger vertigo, take caution and do it slowly
Always have a steady object to hold on to when standing
Warn professionals like dentists, doctors, hairdressers or massage therapists about your vertigo tendencies, so they can be prepared

You should also take all necessary steps to make your home safer in general.

Keep floors clutter-free
Remove small throw rugs, or secure them to the floor
Add grab bars in the bathroom
Have handrails and lights installed on all staircases (inside and out)
Use night lights for when you get up at night

Anxiety and depression is not often discussed as part of vertigo, but the fear of impending episodes (and the possibility of falling) can make seniors especially anxious. You may find yourself limiting activities or going out less. Over time, this can have a detrimental effect on your overall well-being. Regular practice of the above safety precautions along with a clear treatment plan will go a long way toward restoring your confidence.

Advocate for Your Care

Dizziness doesn't have to be accepted as "part of getting older." Although it does recur, that doesn't mean that you need to suffer. Stay informed and ask questions to make sure your symptoms are being managed effectively. If vertigo persists, work with your family and healthcare team to look at alternative treatment options, mental health support and home adaptations for safety.