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Dizziness in Older Adults Flashcards

1
Q

Dizziness occurs in up to ____ of older adults

A

1/3

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2
Q

Prevalence of dizziness increases ___% for every 5 years of age

A

10

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3
Q

___% of cases of dizziness have multiple causes

A

> 50

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4
Q

Classification by symptoms: vertigo

A

Rotational “spinning” sensation

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5
Q

Classification by symptoms: presyncope

A

Sensation of impending faint

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6
Q

Classification by symptoms: disequilibrium

A

Feeling of imbalance on standing or walking

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7
Q

Most common types of dizziness presents with…..

A

Mixed symptoms

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8
Q

What is BPPV?

A

Episodic, inner ear disorder

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9
Q

What event precipitates BPPV?

A

Changes in position (e.g. turning, rolling over)

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10
Q

How long do episodes of BPPV last?

A

5-15 seconds

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11
Q

Pathophysiology of BPPV

A

Changes in endolymphatic pressure during head movements resulting from dislodged otoconia in semilunar canal

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12
Q

What is meniere disease?

A

Idiopathic inner ear disorder

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13
Q

Clinical presentation of meniere disease:

A

Repeated episode of tinnitus
Functional hearing loss w/ sensation of fullness in ears
Severe vertigo
Progressive SNHL

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14
Q

Brain tumors are found in __% of dizzy patients

A

<1

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15
Q

Most common tumor associated with dizziness

A

Acoustic neuroma

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16
Q

Symptoms of acoustic neuroma

A

Unilateral tinnitus & HL predominate (not dizziness)

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17
Q

Bilateral cochlear symptoms (tinnitus, hearing loss) in older persons usually represents

A

Presbycusis

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18
Q

What is presyncope?

A

Sensation of near-fainting

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19
Q

Cardiac causes of presyncope

A

Electrical -> tachy or bradyarrythmias

Structural -> aortic outflow obstruction

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20
Q

Vascular causes of presyncope

A

Orthostatic hypotension

Vagal stimulation

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21
Q

Postural causes of presyncope

A

+/- orthostatic hypotension

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22
Q

What is disequilibrium?

A

Sensation of being unsteady when standing or walking

23
Q

Factors that contribute to disequilibrium

A
  • Propioceptive disorder
  • Visual problems
  • MSK disorders
  • Gait disorders
24
Q

The term ___________ is reserved for patients who do not experience vertigo, presyncope or disequilibrium

A

Lightheadedness

25
Two most prominent considerations in the context of lightheadedness
``` Psychiatric causes (depression, anxiety, somatoform disorders) Idiopathic ```
26
Use of >___ medications = dizziness risk factor
3
27
Certain drugs frequently implicated in dizziness
- Those that cause orthostasis or CNS effects - CV or anti-HTN drugs - Psychotropic medicaitons - AGs - NSAIDs
28
Characteristics of dizziness in older adults
- Resolves in days to several months - Chronic or recurrent - Multifactorial common
29
4 important history elements
1. If dizziness is characterized by spinning, fainting, falling 2. If posture affects sx 3. If there are other sx ass. w/ dizziness (esp. focal neurological) 4. Medications
30
Components of PE
- Check orthostatics - Check hearing (gross first) - Perform provocative test of vestibular system (Head-thrust, Fukuda stepping, Dix-Hallpike) - Cardiac exam - Observe balance & gait (Get up & go)
31
Head-thrust test
Pt. fixates on examiners nose, examiner rotates head rapidly about degrees to left or right (-) = pt. eyes remain fixated on nose (+) = pt. eyes move away from target along with head
32
Fukuda stepping test
Pt. stands in circle on floor, asked to walk when blindfolded w/ outstretched arms, assessor determine s body sway (+) = >30 degree sway to one side = unilateral vestibular lesion or acoustic neuroma
33
Diagnostic evaluation of dizziness
- Labs: HCT, CMP, vitamin B12, folic acid, TSH - Audiometry (esp. if cochlear sx present) - Vestibular testing (refer to ENT) - Neuroimaging (CT, MRI) - ECG - if cardiac cause suspected - Tilt-table test in select pt. w/ postural hypotension or syncope
34
BPPV treatment
Epley's maneuver
35
Meniere disease treatment
Salt restriction, caffeine restriction, diuretics | Vestibular suppressants during acute attacks (e.g. Meclizine)
36
Treatment of ototoxicity d/t medication
D/C med, substitute meds, reduce dosage
37
Treatment of presyncope w/ cardiac cause
Treat CAUSE - Proper hydration - Slow rising from sitting/laying - PT/OT - Pharm therapy for orthostatic hypotension, autonomic dysfunction
38
What med treats orthostatic hypotension?
Fludrocortisone
39
What med treats autonomic dysfunction?
Midodrine
40
Treatment of posprandial hypotension
- Frequent small meals - Avoid exertion after meals - Slow rising from sitting position - Avoid anti-HTN @ or near mealtime
41
Treatment of vertebrobasilar ischemia and/or cerebellar infarcts/hemorrhages
Low dose ASA, clopidogrel or ER dypyridamole; rehabilitation
42
Treatment of acoustic neuroma
Surgery
43
Treatment of PD
Drug therapy, rehab
44
Treatment of peripheral neuropathy
Treat underlying disease
45
Treatment of cervical spine degenerative arthritis, spondylosis
Cervical or vestibular rehabilitation; C collar; +/- surgery
46
What is orthostatic hypotension?
Decrease is systolic BP of 20mmHG or decrease in diastolic BP of 10mmHG within 3 minutes of standing c/t sitting or supine
47
It is normal for both systolic & diastolic BP to decrease __mmHG upon standing
~10
48
Causes of orthostatic hypotension
- Inadequate intravascular volume - ANS dysfunction - Decreased venous return - Inability to increase CO In response to postural changes
49
Clinical presentation of orthostatic hypotension
- Acute or chronic - Lightheadedness - Blurred vision - Dizziness - Weakness/fatigue - Syncope
50
Indications for tilt table test
- High probability of orthostatic hypotension despite an initial negative evaluation - Patients with motor impairment that can't have vital signs taken while standing - Monitor course of autonomic disorder & its response to therapy
51
Acute treatment of orthostatic hypotension
TX UNDERLYING CAUSE | e.g. transfuse, hydrate, D/C offending meds
52
Chronic nonpharm treatment of orthostatic hypotension
EDUCATE, SET GOALS - Remove offending meds or take @ bedtime - Avoid large carb meals - Limit alcohol - Ensure adequate hydration, give water bolus if symptomatic - Supplement sodium (in those who can tolerate it) - LE compression stockings - Exercise & therapy
53
Chronic pharm treatment of orthostatic hypotension
Fludrocortisone (1st line) Midodrine Pyridostigmine

Geriatrics 1 (8 decks)

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