disequilibrium in the elderly

Introduction

A disorder characterized by an unsteady gait, generally in elderly individuals with multiple medical problems.

Etiology

• often multifactorial
• visual impairment:
  • cataracts
• hearing impairment
• deconditioning, muscle weakness or muscle atrophy
• pain
• impairment in proprioception, balance disorder, gait disorder
• CNS disorders
  • Parkinson's disease
  • cerebellar atrophy, cerebellar infarct
  • stroke
  • pontocerebellar angle tumor: acoustic neuroma
• vertebrobasilar insufficiency
• peripheral neuropathy
  • diabetic polyneuropathy
  • vitamin B12 deficiency
• degenerative joint disease of the cervical spine
• orthostatic hypotension
• polypharmacy

Epidemiology

• predominantly a disorder of the elderly

Clinical manifestations

• sensation of dizziness, imbalance &/or unsteadiness that occurs with positional changes, standing, or walking
  • relieved with sitting or lying down
• visual impairment may be present
• numbness
• weakness or incoordination of extremities
• oscillopsia

Laboratory

• peripheral neuropathy
  • serum vitamin B12
  • serum folate
  • serologic test for syphilis
  • thyroid function tests

Complications

• increases risk of falls in the elderly

Differential diagnosis

• vertigo

Management

• physical therapy
  • weight-bearing exercises
  • resistance exercises
• supportive devices
  • eye glasses
  • hearing aids
• medication reconciliation
• fall prevention

More general terms

• dizziness
• disequilibrium
• geriatric disorder; disease of old age; geriatric syndrome