Nursing Care for Dizziness in Elderly Patient
Dizziness in the Elderly
Dizziness is a common and perplexing complaint for older adults and their health providers. The many presentations of the symptom and multiple etiologies make diagnosis and treatment difficult. Since it cannot be seen, the symptom may be discounted by health professionals and treatment may be delayed.
This elusive symptom effecting balance has been associated with falls, fear of falling, anxiety, functional decline, and a decrease in quality of life (Aggarwal et al., 2000; Yardley, 2000). Because dizziness results from impairments or diseases in multiple systems, Tinetti and colleagues (2000) suggested the best approach to dizziness is to consider it a geriatric syndrome.
This designation would lead to a multifactorial approach to evaluation and treatment that has been successful with other geriatric syndromes such as falls and delirium. However, dizziness can often be linked to distinct underlying causes that can be treated ( Drachman , 2000).
Prevalence
The prevalence of dizziness has been reported to range from 24% to 34% of older adults living in the community (Boult, Murphy, Sloane, Mor , & Drone, 1991; Tinetti, Williams, & Gil, 2000). Dizziness increases with age and is more common in women (Boult, Murphy, Sloane, & Drone, 1991; Aggarwal et al., 2000).
A population-based study in a biracial community found a lower prevalence of 9.6% when defining dizziness as a regular symptom that occurred at least once per month ( Aggerwal et al.), and dizziness was not associated with race.
What is Dizziness
Descriptions of dizziness can range from a sensation of spinning or motion to light headedness, fainting or falling, and many variations of these. Balance or the ability to maintain an upright position results from visual, proprioceptive, and vestibular input to the brain. Central integration and engine response are needed.
Dizziness results when there is a mismatch between the messages as to our position in space. Aging can cause decreased efficiency or function in any or all of these balance mechanisms, which may explain the increased incidence of dizziness with age.
The multiple disease processes which can result in a feeling of
dizziness are many, making diagnosis and treatment difficult, and even deciding
which specialist to refer a patient to can be challenging. But clinical characteristics
usually help the practitioner determine a cause.
Symptoms of Dizziness
Recent efforts have focused on defining the symptom of dizziness and its subtypes so that it can be studied empirically in order to develop guidelines for medical practice.
Sloane, Coeytaux , Beck, and Dallara (2001) proposed four subtypes of dizziness: vertigo is the feeling that the surroundings or person is moving or spinning, presyncope is the sensation of feeling faint or lightheaded, disequilibrium is the sense of unsteadiness, and a final category includes other sensations.
While they note that the elderly may have difficulty placing their dizziness
into one of these categories, these subtypes can give clues as to the
underlying cause of the dizziness and appropriate treatment.
Positional Vertigo
Vertigo is often caused by benign paroxysmal positional vertigo (BPPV) and may be caused by displaced otoconial crystals in the inner ear. Acute labyrinthitis and Meniere's disease are also common peripheral vestibular causes.
Vertebrobasilar insufficiency may interrupt blood flow to the vestibular system. Presyncope is often related to cardiovascular causes including orthostatic hypotension, arrhythmia, transient ischemic attacks, carotid sinus hypersensitivity, and vasovagal syncope and is often associated with lightheadedness or syncope more than vertigo.
Disequilibrium can also be due to vestibular causes or balance disorders.
Medication effects, anxiety, and neurological conditions should also be
explored.
Treatment Of Dizziness
Treatments for dizziness in elderly clients are based on the etiology of the symptom. Symptoms arising from cardiovascular disorders are often resolved through medical management.
Postural hypotension may involve ongoing safety measures to avoid dizziness,
lightheadedness, or falls. Benign paroxysmal positional vertigo often responds
to movement therapy designed to move the displaced otoconia, through a 360°
rotation of the head. Medication treatment can decrease the symptoms of
Meniere's disease.
Despite medical strides, many must learn to live with ongoing symptoms. Patients can learn to manage their symptoms through an understanding of situations that exacerbate their symptoms and their responses.
Yardley tested a nursing educational program including exercises that ameliorated anxiety and physical symptoms (Yardley, Beech, Zander, Evans, & Weinman, 1998).
Vestibular rehabilitation using physical
therapy can ameliarate symptoms, and one study has shown that older adults do
just as well as younger adults in responding to a rehab program (Whitney,
Wrisley , Marchetti, & Furman, 2002).
Effects Of Dizziness
Dizziness has a negative impact on quality of life for older adults, causing feelings of insecurity and anxiety (Mendel, Bergenius , & Langius , 2001). Kao, Nanda, Williams, and Tinetti (2001) found dizziness associated with depression, anxiety, gait and balance disorders, medical conditions, and medications.
Others have also found
dizziness associated with falls (Lawson et al., 1999), fear of falling, which
can lead to avoidance of activity (Yardley, 2000), and functional decline
(Aggarwal et al., 2000).
Measure the Effects of Dizziness
Measures to explore the effects of dizziness have been developed. A vertigo symptoms . scale was developed by Yardley, Masson, Verschuur , Haacke , and Luxon (1992) and used to examine the relationship of anxiety and vertigo, and in other studies.
Questionnaires were
completed by 127 patients from a specialty clinic. Factor analysis identified
items for exploring symptoms of vertigo, anxiety, and somatization.
The Inventory for Dizziness
(Hazlett, Tusa , & Waranch , 1996) measures symptoms, responses of
significant others to the dizzy person, and activity levels. The instrument was
an adaptation of a pain inventory, administered to 184 patients presenting to a
specialty dizziness clinic. Factor analysis was used for item selection and
factor development, and support further investigation of the instrument.
Dizziness Handicap
The Dizziness Handicap Inventory (DHIS) (Jacobson & Newman, 1990) was developed to explore the impact of dizziness on everyday life and includes 25 three-level items, and has been used in several studies.
Effects were grouped into three categories: functional, emotional, and physical. The scale was tested in 63 patients who complained of dizziness and findings indicated good test-retest reliability as well as homogeneity of the constructs; another study demonstrated good test-retest reliability.
A short version was developed by Tesio , Alpini , Cesarani, and Perucca (1999) using item-response methodology for item reduction. Dizziness is common and the difficulties of diagnosis and treatment only increase the patient's challenges in managing this uncomfortable symptom.
Some measures have been developed to help understand the problem of dizziness and its impact. Further research is needed to explore the effects of dizziness and interventions to manage the symptoms. As new interventions are available for treatment, additional research into the best ways to educate and deliver information to older adults who suffer its consequences will be needed.
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