The role of rehabilitation for treatment of older adults with dizziness and balance disorders is reviewed. Theories related to functional recovery from peripheral and central vestibular disorders are presented. Suggestions on which older adults might benefit from vestibular rehabilitation therapy are presented. Promising innovative rehabilitation strategies and technologies that might enhance recovery of the older adult with balance dysfunction are discussed.
Poor balance is common in older adults (65 years and older), often leading to accidents and falls, and significant disability. Approximately 30% of the community-dwelling older adults in developed countries fall, with 10% to 20% falling twice or more each year. Tinetti and colleagues reported that 10% of those who fall sustain a serious injury, including hip fractures, dislocation, and head trauma. Nine of 10 patients who sustain hip fracture from falling are age 65 years or older. Twenty percent of patients who fall and sustain hip fracture die within 1 year. Patients who fall more than twice a year are considered frequent fallers. Older adults who fall often develop pain and a low level of confidence in their activities of daily living. A lack of balance confidence may negatively affect functional abilities in everyday life and cause the older adult to change behavior to avoid falling. A change in balance confidence may result in restrictions of mobility and an increase in dependence on others.
Loss of balance resulting in falls in older adults has been linked to dizziness. Dizziness is a well-known problem in the elderly, with a reported prevalence of dizziness in 13% to 38% of older adults depending on the population studied (see article by Barin and Dodson in this publication). Dizziness significantly affects older adults and is more common in women than men. Sloane and colleagues studied the prevalence of dizziness severe enough to require a physician’s consultation or the necessity of medication and found that about 30% of community-dwelling adults experience such dizziness. In people older than 65 years of age, dizziness was found to affect functional ability in activities of daily living (ADL), which was significantly associated with reduced quality of life both physically and psychologically and with worsening of cognitive status. Dizziness is also associated with fear and increased risk of falling. People complaining of dizziness have more locomotor and mental disorders than those who are not dizzy. These worsening physical and emotional states suggest the disabling nature of dizziness. Dizziness is often described in various ways by patients. Table 1 provides common feelings described by patients and what these may mean to a physician.
| Descriptor of Symptom | Definition | Most Likely Cause |
|---|---|---|
| Vertigo | Illusion of movement either of the person or of the visual surround | Peripheral or central vestibular disorder |
| Disequilibrium | Imbalance or unsteadiness but without vertigo | Somatosensory abnormality Visual illusions Cerebellar disorders |
| Presyncope | Lightheadedness that occurs just before fainting without vertigo | Vascular problem |
| Psychophysiologic | Refers to combination of symptoms like floating, rocking, swimming, or internal spinning or a feeling of being removed from one’s body | Anxiety disorders Central disorders |
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