Assessing the Older Person with Dizziness Flashcards
What is BPPV?
Benign paroxysmal positional vertigo
Vertigo
The hallucination of movement
What makes the older person’s assessment different?
- Multiple Morbidities
- Polypharmacy
- Altered Sensation
- Limitations in ROM and flexibility
- Age related changes to vestibular apparatus
- Age related changes to central nervous system
Why do older people get dizzy?
•Older adults may not report the same intensity of symptoms
–Type 1 hair cells are lost with aging
–Neuronal loss occurs with aging–
•Older adults adapt…and don’t realize it!•–Multiple pillows for sleeping–Turning their whole body rather than just their head–Standing back to look upward––
Other causes of dizziness
- Alcohol
- AF
- Drugs
- Syncope
- Low blood glucose
Cardiac issues related to dizziness
- Arrhythmia
- Bradycardia / Tachycardia
- Atrial Fibrillation
- 2 bedroom terrace house with plumbing = arteries, electricity (generator) = electric impulses
- Not position dependent
- Variable duration
- Can be accompanied by anxiety, shortness of breath, sense of “something bad!”, sweating, and /or pallor
- Exertion induced
- Postural Hypotension
- Upon arising quickly from seated or supine
- With bending over
- Generally resolves quickly
How to detect irregular rhythm?
Lying and standing blood pressure (significant and symptoms of it)
Significant:
- Systolic drop 20mmHg or more
- Systolic drop below 100mmHg
- Diastolic drop 10mmHg with symptoms
Symptoms:
- May be more relevant than “significance”
- Older adults, particularly with co-morbidities, can be more imbalanced with less than significant drops.
Medications causing dizziness
- Proton pump inhibitors
- ACE inhibitors
Side effects of ACE inhibitors
Lab values of HbA1c and Serum vitamin D
- HbA1c–(20-41.9 mmol/mol)–(48-59 mmol/mol for diabetics)–Gives good long range value for blood glucose control–Ideally done quarterly
- Serum Vitamin D–(50 – 175 nmol/L)–Older adults have been shielding for over a year–Older adults have been conditioned to avoid excessive sun exposure–Older adults don’t process UV B as effectively
Recurrence of BPPV is linked to being Type 2 diabetic with low vitamin D
diabetic with low vitamin D
Causes of sensation loss
- Physiological
- Diabetes
- Alcohol excess
- Self imposed
- Inappropriate footwear
Whats wrong with alcohol and the elderly?
- Neurological depressant
- Medication interactions
- Cognitive dysfunction
- Vasodilation (orthostasis)
- Light cupula = decreases density of the blood so causes the hair cells to move and become activated hence, room spins
What are adaptations in older people?
- Stiff neck
- Kyphotic spine
- Fear
- Arthritic spine
‘Normal’ presentations in older people
- Gaze evoked nystagmus (particularly at end range) may be normal
- Limited upward gaze is normal
- Smooth pursuit may have some saccadic intrusions which are age related and normal
How to test for significant kyphosis?
- Using a pillow under the shoulders and letting the head rest on the surface of the bed is as effective as dangling off the edge of the bed
- Significant kyphosis may call for a thin pillow or even none at all!
