title: Dizziness and Unstable Gait in Old Age: Etiology, Diagnosis and Treatment.
abstract: BACKGROUND
  Dizziness and unsteady gait are common in the elderly but are too often dismissed as supposedly nonspecific, inevitable accompaniments of normal aging. For many affected persons, the factors leading to dizziness and gait impairment in old age are never identified, yet some of these factors can be specifically detected and treated.
  
  
  METHODS
  This review is based on publications (2005-2014) retrieved by a selective search in PubMed on the terms "aging," "dizziness," "elderly," "gait," "gait disorder," "geriatric," "locomotion," and "vertigo."
  
  
  RESULTS
  Dizziness interferes with the everyday activities of 30% of persons over age 70 and is so severe that it constitutes a reason for consulting a physician. The more common causes of dizziness and unsteady gait in old age are sensory deficits, such as bilateral vestibular failure, polyneuropathy, and impaired visual acuity; benign paroxysmal positioning vertigo; and central disorders such as cerebellar ataxia and normal-pressure hydrocephalus. Further relevant factors include sedative or antihypertensive medication, loss of muscle mass (sarcopenia), and fear of falling. Many elderly persons have multiple factors at the same time. Benign paroxysmal positioning vertigo can be effectively treated with specific physical maneuvers. Sedating drugs are indicated only for the treatment of acute rotatory vertigo and are not suitable for long-term use. Sarcopenia can be treated with physical training.
  
  
  CONCLUSIONS
  If a specific cause can be identified, dizziness and gait unsteadiness in old age can often be successfully treated. The common causes can be revealed by systematic clinical examination. Controlled clinical trials on the efficacy of treatments for elderly persons are urgently needed.
authors.affiliation: German Center for Vertigo and Balance Disorders, Großhadern Hospital, Ludwig-Maximilian-Universität, München, Schön Klinik Bad Aibling, Basel University and University Center for Geriatrics and Rehabilitation, Felix Platter Hospital, Basel, Switzerland, Institute for Clinical Neurosciences, Großhadern Hospital, Ludwig-Maximilian-Universität, Munich, Neurological Clinic and Policlinic, Großhadern Hospital, Ludwig-Maximilian-Universität Munich.
authors.forename: Klaus
authors.initials: K
authors.lastname: Jahn
authors.forename: Reto W
authors.initials: RW
authors.lastname: Kressig
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Bridenbaugh
authors.forename: Thomas
authors.initials: T
authors.lastname: Brandt
authors.forename: Roman
authors.initials: R
authors.lastname: Schniepp
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D004244:Dizziness / Q000175:diagnosis* / Q000209:etiology / Q000628:therapy*; D019317:Evidence-Based Medicine; D005260:Female; D020233:Gait Disorders, Neurologic / Q000175:diagnosis* / Q000209:etiology* / Q000628:therapy*; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D012678:Sensation Disorders / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D016896:Treatment Outcome