The Dizzy Mystery

By Ian K. Smith, M.D.

Remember the childhood thrill of twirling in circles until the world spun wildly and you couldn't stand on your feet? That's how many of my former patients described their disorienting bouts with dizziness--especially the elderly ones. As many as 38% of older Americans struggle to keep their world stationary, trying to avoid dangerous falls and potentially life-threatening injuries. Dizziness is so common among seniors that patients and their doctors tend to write it off as an inevitable consequence of aging.

That can be a big mistake, suggests a study published last week in the Annals of Internal Medicine. Dizziness can be caused by a wide variety of underlying conditions, some of them quite serious. Many of these conditions, if properly identified, can easily be treated.

In the new study, 1,000 elderly Americans were questioned closely about the frequency of their dizzy spells and the conditions that surrounded them. Were they sitting or lying down? Had they just stood up? What sensations accompanied the dizziness?

Dizziness, it soon became clear, is a chronic condition for many seniors. Nearly 25% reported that they had been suffering from dizziness for more than a month, 15% for at least a year. Their dizzy spells were most often triggered by getting up quickly, turning the head or entire body, or being upset or anxious.

Dizziness can usually be traced to the body's master balance system, the semicircular canals located in the inner ear. This delicate and complicated stabilizing mechanism can be disrupted by everything from viral infections to structural injuries--as well as the slowed reflexes and lowered blood circulation that are a natural result of aging. Nothing can be done about that.

But dizziness can also be caused by a variety of treatable disorders, including degenerative joint disease in the neck, damaged blood vessels in the brain and cardiovascular illnesses, such as coronary-artery disease and a slow heartbeat. Identifying the culprit can be particularly difficult in older patients who commonly suffer from more than one health problem at a time.

You can help your doctors make a diagnosis by keeping an accurate diary of your dizzy spells. What were you doing before they happened? How long did they last? Were you nauseous or light headed? What medications are you on? (Dizziness is a well-documented side effect of some drugs taken alone or in combination with others.)

Headache and antinausea medications can help reduce the effects of dizziness, but treating the symptoms is only a temporary fix. Better to be safe and schedule some time in the doctor's office, answering questions and undergoing a quick exam. Bring your dizziness diary and be prepared for a complete physical exam that includes neurological and musculoskeletal testing. Before you accept the answer "You're just getting old," make sure the problem isn't something more serious.

Last year my colleague Christine Gorman expressed skepticism in this space about a report that night-lights could trigger nearsightedness in infants. Now two follow-up studies have failed to prove the connection. For more information on night-lights, visit spectacle.berkeley.edu/cleere For more on dizziness, visit time.com/personal You can e-mail me at [email protected]