Balance Disorders in the Elderly


As we age, we are more likely to encounter health and wellness challenges, but also experience more serious repercussions from these challenges. In particular, dizziness and balance disorders, including vertigo, are a cause for concern. These kinds of disorders are a strong predictor of falls in the elderly, which is the leading cause of death in people 65 years and older.

Assisted Living Education reviews some common balance disorders and treatments, as well as precautions we can take to ensure our elderly residents’ safety.

Balance Disorders

Balance disorders cause people to feel dizzy, faint, or unsteady on their feet.  Some people can even experience sensations of movement, spinning, or floating while sitting or lying down.  In general, balance disorders often stem from medical conditions relating to the heart, nerves, bones and joints, muscles, vision, and the inner ear. However, most problems with balance are related to problems with the inner ear, also called the vestibular system.

The Basic Structure of the Inner Ear
The inner ear contains fluid-filled semicircular canals; inside these canals are tiny, hair-like sensors.  These sensors monitor the rotation of a person’s head.  The inner ear also contains otolith organs; these organs monitor the up/down, left/right, and back/forward movements of the head.  The otolith organs contain calcium crystals that allow for sensitivity to gravity.

Vertigo and Benign Paroxysmal Positional Vertigo

Vertigo is a term that refers specifically to the sensation of spinning, or the sensation that the inside of one’s head is spinning.  It is associated with a variety of conditions, but the most common cause of vertigo is a condition called Benign Paroxysmal Positional Vertigo (BPPV.) BPPV occurs when the calcium crystals in the otolith organs become dislodged from their regular positions and move to another location in the inner ear.  For example, when a person is lying down, the crystals can move into the semicircular canals.  As a result, the semicircular canals might respond differently than they normally would to a change in head position.  This leads to a feeling of vertigo and/or dizziness.  BPPV is usually triggered by specific changes in the position of the head – usually a person will notice a sensation of vertigo after his or her head makes a particular head movement, such as tilting the head up or down, or turning over in bed.

In addition to vertigo, BPPV also causes episodes of mild to severe dizziness, unsteadiness, nausea, vomiting, and nystagmus (abnormal rhythmic movements of the eyes.)  Typically, symptoms are brief in duration, usually lasting a minute or less.  Symptoms can also disappear for a long time and then recur.

Benign Paroxysmal Positional Vertigo in the Elderly

Most of the time, BPPV is not serious and its occurrences are short-lived, but in older people, it can increase the risk of falls.  It also tends to be more common in women than in men.  There are precautions that vertigo sufferers as well as assisted living facilities can take to prevent a fall:

  • Resident can use a cane for support when walking.
  • Facilities can ensure that common areas and resident living environments are well lit at night.
  • The resident should be educated to sit down as soon as possible if vertigo or dizziness arises, or notify nearest staff member.
  • Residents should avoid positions and situations that would likely cause a loss of balance. Facility staff should be able to anticipate a precarious situation in order to prevent an accident.
  • If possible, susceptible residents should discuss symptoms with attending doctors or personal physicians for management or further treatment.

Other Causes of Vertigo

Other causes of vertigo include migraine headaches, head injuries, motion sickness, or more rarely, Meniere’s Disease (vertigo accompanied by fluctuating hearing loss and ringing of the ears,) Acoustic Neuroma (a benign tumor on the auditory vestibular nerve,) Vestibular Neuritis (inflammation of the vestibular nerves,) or Ramsay Hunt Syndrome (a shingles infection affecting the facial nerve near one of the ears.)

Treating BPPV

BPPV can sometimes go away without treatment in a few weeks or months, but it is generally recommended that an individual see a doctor for unexplained vertigo that happens periodically for more than a week, or for episodes that last longer than a minute.  A doctor may recommend one of the following treatments:

  • Canalith repositioning – This procedure involves slowly maneuvering the patient’s head into different positions.  In effect, these maneuvers move the particles inside the inner ear from one area to another.  The doctor moves the patient’s head into a particular position, waits for the patient’s symptoms to cease, then continues to hold the head in that position for about 30 seconds.  This procedure is often effective after the first or second treatment, and patients can learn how to perform the procedure on themselves at home.
  • Surgery – When canalith repositioning is not effective, the doctor may suggest a procedure in which a plug made of bone is surgically placed to block the section of the inner ear that is causing the patient to have vertigo or be dizzy.  When this plug is in place, the semicircular canal is then no longer able to react to movements of the head.  This surgery is 90% effective at resolving symptoms.
  • Medication – Sometimes doctors may prescribe medications for dizziness or vomiting stemming from vertigo that lasts for hours.

As with any concern, symptoms, or disorder, the resident’s attending or personal physician should be consulted before proceeding with any treatment or management program. Nurses, CNAs and other facility staff should note any acute physical or behavioral changes observed and relay them at shift changes. This is especially important since some of our elderly residents have lost the ability to effectively communicate even basic needs, and may have trouble articulating their symptoms.

Assisted Living Education is committed to the highest quality education and services for the assisted living community. Our instructors are industry professionals with years of real-world experience, and teach their courses with engaging and meaningful methods. Assisted Living Education offers courses in RCFE Certification, Staff Training classes, online RN, LVN, and SNF courses, and more! Visit our contact page for any inquiries or give us a call at 1-855-200-0188 for immediate assistance.

About Assisted Living Education
Assisted Living Education has been operating in and improving the growing senior care industry for over 15 years. Founded by certified RCFE administrators, Jane Van Dyke-Perez and Bill Perez, we have licensed more than 1,100 assisted living facilities and built close relationships with the California Department of Social Services, assisted living managers, owners and industry professionals. As senior living care educators ourselves, we strive to contribute our knowledge and skills to continually improve senior care and the satisfaction of those working in the industry.