Dizziness

A Seabrooker complained to me recently that he had started feeling dizzy from time to time. This is a common problem among older people. In fact, the incidence in the medical literature ranges from about 10 to 40 percent of people over 65. The definition of chronic dizziness is repeated (over at least 1 month) episodes of feeling dizzy, light-headed, faint, spinning or unsteadiness. When describing the dizziness a number of sensations are reported alone or in combination - see table 1. Among those who have chronic dizziness, it most commonly lasts either less than a minute (33 percent of people) or under 2 hours (40 percent.) About a third of people with chronic dizziness have daily bouts and the rest have only occasional episodes during a month.

A team of geriatric physicians at Yale University have actively investigated dizziness and even have proposed that it is "Geriatric Syndrome" that can be caused by many different things. There are a host of medical diseases which can produce dizziness - these include neurological entities related to brain blood flow like carotid artery or other cerebrovascular diseases and even heart problems such as aortic valve stenosis or congestive heart failure. There are other neurologic diseases such as Parkinson's, alcoholism and psychiatric conditions such as depression and anxiety can be associated with dizziness. Other medical problems like diabetes can cause dizziness, especially when blood glucose is low. A certain number of episodes are related to medications and combinations of medications. If you read your medication labels you will often find dizziness listed as a side effect and some of the medications cause orthostatic hypotension (a condition in which standing causes the blood pressure to decrease) which easily explains dizziness by the mechanism of reduced blood supply to the brain. 

A number of activities can also precipitate dizziness such as strenuous exercise with resultant dehydration - something that we at Seabrook can do in the summer if we are not careful about drinking plenty of fluids. Also, changes is position are commonly reported as precipitating events. Most people (74 percent) say their dizziness is provoked by several activities that tend to be related to motion. Some of the common activities reported by people who chronically experience dizziness are listed in table 2. What we do not know is whether anything can be done to reduce these triggering events such as getting up more gradually - this is preventive if the cause is postural hypotension, but postural hypotension is not the usual cause.

The Yale group has reported some mixed news about dizziness. The good news is that when patients with chronic dizziness have been followed for a year, they do not have a higher mortality, heart attack rate, higher stroke or even higher hospitalization rate. All this means that dizziness does not seem to have an ominous health impact. Does this mean that those who do suffer this common chronic problem just need to forget it or ignore it? No, the bad news is that in the surveys used to follow these people there is an increased incidence of falls and fainting. They also have more problems with depressive symptoms, feelings of good health, and less social interactions. The discerning reader will say, well these are all inter-related problems and that is true. In fact, there is a very mysterious relationship between dizziness and depression and anti-depressant medicines which is yet to be solved, but which clearly affects the function of someone with chronic dizziness.

What can be done about this if you are one of the many people who have bouts of dizziness? As a physician we always advise trying to figure out if the symptom (dizziness) is an expression of a correctable or controllable disease, and certainly one needs to go over the medications one is taking with your doctor to be sure that these are not the cause. Common sense would dictate that to prevent falls one should try to learn what activities do precipitate the spells and avoid them or limit the rapidity of executing them. Finally, use of hand-rails and other supports when dizziness occurs might reduce the risk of falls. If one suspects the dizziness is a result of depression, then this should be mentioned to your doctor since this is often treatable. The best advice I had for my Seabrook friend was to try to learn when to expect dizziness and take precautions to not allow a fall. It is little consolation that this is a very common problem, but some that it is probably not likely to have very serious medical consequences.

Table 1. Dizziness Sensations

Dizziness Sensation Description – Percent (%)

Loss of Balance (Disequilibrium, Unsteadiness) - 59%

• Only Sensation - 22%
• Plus Other Sensations - 37%

Spinning (Vertigo, Perception of Movement) - 33%

• Only Sensation- 10%
• Plus Other Sensations - 24%

Near Faint (like passing out) - 42%

• Only Sensation - 12%
• Plus Other Sensations - 30%

Sensations described by patients 72 years of age or older with dizziness as a percent of all with chronic dizziness.
From Tinetti in Annals of Internal Medicine, March 7, 2000.

Table 2. Activities Most Often Associated with Dizziness

Activity – Percent (%)

Getting Up From Lying Down - 54%
Turning Head - 41%
Turning Body - 38%
Getting Up From Sitting - 31%
When Upset - 31%
Walking - 26%
Head in Specific Position - 21%
Standing Still - 16%

 Actions  described by patients 72 years of age or older with dizziness as a percent of causes of their dizziness. 

Note that many people report many activities and this explains why the addition of activities results is more than 100 percent. From Tinetti in Annals of Internal Medicine, March 7, 2000.

Common Causes

Lightheadedness happens when there is not enough blood getting to the brain. This can happen if there is a sudden drop in your blood pressure or you are dehydrated from vomiting, diarrhea, fever, or other causes. Many people, especially as they get older, experience lightheadedness if they get up too quickly from a lying or seated position. Lightheadedness often accompanies the flu, common cold, or allergies.
More serious conditions that can lead to lightheadedness include heart problems (such as abnormal heart rhythm or heart attack), stroke, and severe drop in blood pressure (shock). If any of these serious disorders is present, you will usually have additional symptoms like chest pain, a feeling of a racing heart, loss of speech, change in vision, or other symptoms.