A Tailored Approach to Dizziness: Take extra caution and care in the elderly, panelists say

Dr. Gottshall said there are several questionnaires that can be used to get a sense of a patient’s quality of life and determine what they want to do that they can’t. In response to demands from patients, the Functional Gait Assessment was developed, which is based on the traditional Dynamic Gait Index, but with three new tasks, including “gait with narrow base of support,” walking backwards, and walking with the patient’s eyes closed.

There are also virtual reality exercises, in which a patient uses computer simulation to complete common tasks or take part in games that improve balance. The objective should be to meet the patient’s goals for therapy more exactly, she said.

“We can ask them six to eight weeks later and say, ‘Oh, you’re compensated,’ and yet they don’t feel like they can go out into the environment of their house and be successful and not be anxious,” Dr. Gottshall said.

Prevention

That said, it is still a fact that falls are among the most serious problems associated with dizziness among the elderly, said Yael Raz, MD, assistant professor of otolaryngology at the University of Pittsburgh School of Medicine.

Studies have found that 35 to 40 percent of healthy adults age 65 or older fall at least once a year. And those with disequilibrium fall four times more frequently than controls, other studies have found. Plus, 95 percent of hip fractures result from falls and 25 percent of patients with hip fractures die within one year, Dr. Raz said.

She said otolaryngologists should address fall prevention, even if the source of the dizziness does not stem from the inner ear. Ways to intervene include promoting exercise, addressing vision problems and exploring a reduction in medication, she said.

“I think we all have a tendency to think, ‘Oh, they’re coming for dizziness but it’s not an inner ear problem, this is not vestibular in origin,’ and send them off to another specialist,” she said. “Those visits represent a chance to make an intervention that could have a huge impact.”