Symptoms of Vertigo in the Elderly

By Dr. Prateek Porwal, ENT Surgeon & Vertigo Specialist | PRIME ENT Center, Hardoi UP
Last Updated: February 2026 | VAI Budapest 2025 Award Recipient

Vertigo in Older Adults: Recognizing Symptoms and Getting Proper Care

In my practice, vertigo in elderly patients presents differently than in younger people. A 75-year-old patient may describe their symptoms as “unsteadiness” or “dizziness,” not realizing they’re experiencing true vertigo. Understanding how vertigo manifests in older adults is crucial because age-related complications—falls, fractures, loss of independence—make early recognition and treatment even more important.

How Vertigo Presents in Older Adults

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The primary symptom of vertigo is the sensation that you or your surroundings are spinning. However, elderly patients often describe vertigo differently than younger patients. Older adults frequently report:

• Generalized dizziness: “The room feels unsteady” or “I feel woozy”
• Loss of balance or unsteadiness: Difficulty walking steadily, feeling wobbly
• Lightheadedness: Feeling faint or ready to black out
• Nausea and vomiting: Though typically less severe than in younger patients
• Difficulty walking in darkness: Particularly noticeable when visual cues are absent
• Fear of falling: A pervasive worry affecting confidence and activity
• Hearing-related symptoms: Tinnitus (ringing), hearing loss, ear fullness
• Cognitive complaints: “Brain fog,” difficulty concentrating, feeling mentally unsteady

Key Difference: Elderly vs. Younger Patients

Here’s what I observe: younger patients with BPPV report the classic “room is spinning” sensation. Elderly patients with the same condition more often say “I feel dizzy and unsteady” without describing the rotational component. This difference makes diagnosis trickier in older adults—yet Dix-Hallpike testing shows the same BPPV pathology.

Additionally, older adults are more likely to report multifaceted symptoms involving multiple sensory systems (vision, proprioception, vestibular), reflecting the age-related decline in balance mechanisms.

Why Vertigo Matters More in the Elderly

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The consequences of untreated vertigo in older adults are serious:

• Fall risk: Vertigo increases fall risk 2.4 times in elderly people. Falls in this population often result in hip fractures, which have a 20% one-year mortality rate.
• Injuries: Head trauma from falls can cause subdural hematoma, stroke, or other serious brain injuries.
• Loss of independence: Many elderly patients become housebound after falls, losing autonomy and quality of life.
• Psychological impact: Anxiety about falling leads to activity avoidance, deconditioning, and depression.
• Complications: Falls often trigger hospitalizations, which in older adults can trigger delirium, infection, and further decline.

Common Causes of Vertigo in Elderly Patients

BPPV

BPPV accounts for 50% of vertigo in patients over 70. It’s caused by displaced calcium crystals in the inner ear and is highly treatable with repositioning maneuvers. Many older adults with BPPV don’t recognize it as vertigo—they just feel unsteady.

Vestibular Neuritis and Labyrinthitis

These viral-induced conditions cause sudden, severe vertigo often lasting several days. Recovery is slower in older adults than younger patients.

Vestibular Migraine

Surprisingly common in older adults, though older patients may not realize migraines can cause vertigo without significant headache.

Age-Related Changes

Natural age-related decline in the vestibular system, combined with changes in vision and proprioception, causes balance problems. This “presbystasis” or multisensory dizziness is common in older adults.

Medication Side Effects

Many medications elderly patients take—blood pressure drugs, sedatives, antidepressants—can cause dizziness or vertigo. Polypharmacy (taking multiple medications) increases this risk.

Cervical Vertigo

Arthritis and dysfunction in the neck can cause dizziness and balance problems in older adults.

The Diagnostic Challenge in Older Patients

Diagnosing vertigo in older adults requires extra care:

• Vague symptom descriptions: “Dizziness” is nonspecific; distinguishing true vertigo from other balance problems requires detailed history-taking
• Multiple causes: Older adults often have multiple conditions contributing to dizziness simultaneously
• Cognitive factors: Patients with memory issues may struggle to describe symptom onset or progression accurately
• Falls vs. vertigo: An older patient may present with a fall and minimize dizziness, when actually vertigo caused the fall

My approach in evaluating elderly vertigo patients includes:

• Careful history from patient and family/caregiver
• Thorough physical exam including Dix-Hallpike test and other vestibular maneuvers
• Medication review (many drugs cause dizziness)
• Vision and proprioception assessment
• Balance and gait evaluation
• Vestibular testing if indicated
• Imaging (MRI/CT) if central causes are suspected
• HINTS exam to help distinguish stroke from inner ear causes

Treatment for Vertigo in Older Adults

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Vestibular Rehabilitation Therapy

VRT is particularly beneficial for older adults. It’s non-medication, helps the brain compensate for vestibular loss, and improves balance and confidence. Even frail elderly patients benefit from gentle, progressive vestibular exercises. VRT also helps prevent falls—reducing fall risk by up to 70% in some studies.

Repositioning Maneuvers for BPPV

The Dix-Hallpike test and Epley maneuver are very effective in older adults. Treatment often works in one or two sessions, providing rapid relief and preventing falls.

Medications in the Elderly

Medication use in older adults requires caution:

• Short-term vestibular suppressants: Antihistamines help acute symptoms but can increase fall risk if used long-term
• Avoid benzodiazepines: These significantly increase fall risk in older adults
• Review current medications: Often, stopping or adjusting medications causing dizziness solves the problem
• Treat underlying conditions: If blood pressure medications are causing dizziness, adjustment helps without adding new drugs

Lifestyle and Home Modifications

• Home safety: Remove trip hazards, improve lighting, install grab bars
• Assistive devices: Canes, walkers, or other devices improve confidence and safety
• Hydration and nutrition: Dehydration and low blood sugar worsen dizziness
• Sleep and activity balance: Adequate sleep reduces symptoms; gentle activity maintains strength and balance
• Vision correction: Proper glasses help with balance
• Fall prevention programs: Tai chi, balance classes, or supervised exercise programs reduce fall risk

When to Seek Urgent Care

In elderly patients with vertigo, seek immediate medical evaluation if they develop:

• Severe headache with vertigo
• Weakness or numbness
• Speech difficulty or facial droop (signs of stroke)
• Vision loss
• Severe fall or head trauma
• Fever and vertigo together

Key Points for Elderly Patients and Families

If you’re an older adult with vertigo or the family member of one:

• Don’t dismiss symptoms: Dizziness in older adults isn’t “just a part of aging”—it’s treatable
• Describe symptoms carefully: Help your doctor understand when symptoms occur, what they feel like, and how they affect you
• Prioritize fall prevention: This is often more important than symptom relief alone
• Consider vestibular rehabilitation: It’s safe, effective, and addresses the root problem rather than just masking symptoms
• Regular follow-up: Improvement may take weeks; periodic check-ins ensure you’re progressing
• Lifestyle matters: Sleep, hydration, activity level, and stress management all affect symptoms

 

FAQs: Vertigo in Older Adults

Is dizziness in older adults always vertigo?

No. Dizziness has many causes (low blood pressure, anemia, dehydration, medication effects, vision problems, balance problems). True vertigo—spinning sensation—is specific. Proper evaluation determines the cause.

How common is vertigo in people over 70?

Approximately 8-10% of adults over 70 experience vertigo in any given year. Some studies suggest even higher prevalence, making it a major health concern in this population.

Can BPPV be treated in older adults?

Yes. Repositioning maneuvers (like Epley) work as well in older adults as younger patients, providing relief in 80-90% of cases. Frailty doesn’t usually prevent treatment.

Are medications safe for treating vertigo in older adults?

Some medications increase fall risk and confusion in older adults. Non-medication approaches like vestibular rehabilitation are often preferable. If medications are used, they should be for short-term symptom relief, not long-term management.

How can I reduce fall risk from vertigo?

Use assistive devices, improve home lighting and remove hazards, participate in balance-enhancing activities like vestibular rehabilitation or tai chi, maintain adequate nutrition and hydration, and ensure proper medication management.

Is vestibular rehabilitation suitable for frail elderly?

Yes. VRT can be adapted for any fitness level. Even gentle exercises, performed consistently, help improve balance and reduce fall risk.