Current Insights into Treating Vertigo in Older Adults

Abstract

The number of older people has been increasing over recent decades in Western populations. Dizziness, imbalance, and vertigo constitute some of the most common complaints in older patients, and risk of falling is the most frequent and worrying consequence. It has been reported that 15-20% of the adult population experiences these debilitating symptoms. Among the diseases that may be associated with vertigo, the three classes of otological, central, and functional (psychological) dizziness may be distinguished. Overall, vestibular disorders account for 48% of vertiginous complaints in the older population. The main focus of this article is to review the forms of pharmacotherapy for vertigo, especially with regard to older patients, who may be treated simultaneously with other drugs for different comorbidities. Interactions with other drugs should be considered in the choice of a particular course of treatment. Moreover, overuse of pharmacotherapy for the management of vertigo in the elderly may prevent the development of the central compensatory mechanism that sustains both static and dynamic imbalance after a vertiginous crisis. In the majority of patients, vestibular and physical rehabilitation are strongly advised and rarely contraindicated.

Fig. 1

Distribution of the most frequent vestibular diagnoses relative to age (< 45 and > 65) in 565 patients referred to the Center of Balance Disorders of the Ear Nose and Throat Department, Pisa University Hospital (January 2016–December 2019). AUV acute unilateral vestibulopathy, BPPV benign paroxysmal positional vertigo, MD Menière’s disease, PPPD persistent postural-perceptual dizziness, pts patients, VM vestibular migraine, VV vascular vertigo