When the carousel in the head does not stand still

Dizziness in old age is one of the main geriatric problems and is more than just a condition. Therefore, it should be treated quickly and effectively to prevent falls and the increased risk of mortality that accompanies them. In addition to physiotherapy and cognitive training, pharmacological interventions include antivertiginosa.

When health declines occur in old age, they usually take place in the area of physical functions. Especially immobility, instability and incontinence are common. But changes can also be observed intellectually. In addition, there is isolation, iatrogenic drug effects, depression, and ultimately senile dementia. This is a limitation of spatial orientation, which is nowadays also called multimodal vertigo. This is usually due to impairments of both the central and peripheral nervous system (Table 1) .

Dizziness can occur at any age, but the frequency increases considerably with age. In a study, around one in five older people over the age of 65 stated that they had been affected by dizziness and balance problems in the past 12 months. While the prevalence in a different group of seniors was on average 36% (women) and 29% (men), it was 51% and 45% in the very old (88-90 years).

Dizziness leads to a loss of mobility and participation in age-appropriate activities and therefore significantly restricts quality of life. Because dizziness frightens many people and makes them insecure and overly cautious. Those affected leave the house less often and move less and less overall. This means that the entire balance system and the musculature of the musculoskeletal system are hardly challenged and lose functionality. However, the more inactive the lifestyle is, the faster the ageing process progresses and a vicious circle begins (Fig. 1). In addition, multimodal dizziness increases the risk of falling per se by a factor of 2.6. This in turn is associated with an increased mortality by a factor of 3. Therefore, the risk of falling should be reduced – also to avoid chronification by the “dizziness memory”.

Reduce the risk of falls, improve quality of life

Effective therapy is multimodal in design and consists of activating physical therapy, mitigation of the living environment, critical indication for walking aids, avoidance of sedating medications, and use of nonsedating antivertiginous agents. The latter have a calming effect on the vomiting center in the brain and on the balance center. These include, among others, the combination of cinnarizine and dimenhydrinate, in addition to ginger, cocculus and betahistine. While ginger shows evidence of efficacy in hyperemesis gravidarum, betahistine is used primarily in Meniere’s disease. Cinnarizine and dimenhydrinate should be used as a fixed combination, as this can reduce dizziness better than the single substances. Cocculus is one of the natural medicines. All components (Anamirta cocculus, Ambra grisea, Conium maculatum and Petroleum rectificatum) strengthen the blood circulation of the vessels in the brain, improving the processing of sensory impressions responsible for a stable balance. Since the treatment is symptomatic and not curative, pharmacological intervention is usually used as a continuous therapy.

Vestibular, visual and propioceptive training are available for physical treatment. With Balanceboard, Health Games or MemoreBox, patients can exercise independently. A combination of physiotherapy and cognitive training (dual tasking) has proven to be effective. Successful fall prevention studies with interventions such as Tai Chi or Dalcroze Rhythmics achieved an average fall reduction rate of around 50% and were based on methods that traditionally require and promote motor and cognitive skills at the same time.