When Older People Get Vertigo & How To Continue Moving Independently & Avoid Falls

A third of 70 year olds and over half of people by age 85 experience the symptoms of dizziness or vertigo.(1)(2) Over half the time, the main cause of this dizziness/vertigo with older people is a disorder called Benign Paroxysmal Positional Vertigo (BPPV).(3)   BPPV happens when crystals in the inner ear balance system (The Vestibular System) move from a place where they normally are located to a place where they should not be located.(4)(5)(6) The great news is BPPV is completely treatable in the vast majority of cases by a simple repositioning maneuver.(7)(8)(9)(10)(11)

The challenge is the diagnosis and treatment for BPPV is already a problem in the current healthcare system due to expensive(12)(13)(14) over-medication and imaging(11)(12)(13)(14)(15)(16) and very little use of these simple repositioning maneuvers.(11)(16)

What makes BPPV even more difficult with the older population is the symptoms are not as clear-cut compared to younger people,(17)(18)  making the dizziness amongst older people even more difficult to sift through for healthcare providers.

While the symptoms for BPPV are usually a spinning sensation, especially when rolling over in bed,(16) older people may more frequently describe more of an unsteadiness(17)  and different types of dizziness.(18)  Older people also take longer to get a diagnosis(18) and even to seek treatment.(17)

The difficulty of healthcare providers to recognize BPPV accurately in older people is especially problematic since vertigo results in more falls and even fractures.(19)  Simply treating BPPV dramatically decreases falls even if nothing else is done.(20)(21)  But BPPV often goes unrecognized in the older population.(22)

So you may be asking: Ok… So if it’s as easy as a repositioning maneuver to move the crystals, who do you see about that?

A trained experienced specialist (11)(23)(24) is able to diagnose(25) and treat(26) BPPV properly. They will also be able to recognize if something even more serious or life-threating is the cause of the vertigo(27) and then refer you to the appropriate healthcare provider.

These specialists are often-times called Vestibular Specialists. Vestibular Specialists are healthcare providers who specialize in the inner ear balance system and its holistic effects on the body.

What About Preventing Vertigo?

 

We are now learning there are ways to reduce the risk of BPPV in the first place. Scientists are now seeing a big connection with BPPV and bone health(28)(29)(30)(31) and when people have a combination of medical problems.(32)(33) In fact, factors that by themselves determine whether someone will get vertigo are blood pressure, cholesterol, stroke, and migraine.(16)

So working on your health pays off.

Like many things, we are now learning that eating well, exercising, and inquiring with your doctor about your bone health could pay big dividends when thinking about maintaining independence as you get older and preventing dizziness and vertigo.

If you are feeling symptoms of dizziness/vertigo, and you and your doctor have not figured out the cause, or suspect the problem is inner ear balance related, ask your doctor if a Vestibular Specialist would be right for you to figure out the cause of your dizziness or vertigo.

And in the meantime, keep exercising, moving, and living life.

 

To Read About More Powerful Solutions To Take Charge Of Your Vertigo Click Here To Download Our Free Tips Report

 

Health Advice Disclaimer

We make every effort to ensure that we accurately represent the injury advice and prognosis displayed throughout this blog. However, examples of conditions and their prognosis are based on typical representations of those conditions that we commonly see in physical therapy. The information given is not intended as representations of every individual’s potential condition. As with any injury, each person’s symptoms can vary widely and each person’s recovery can also vary depending upon background, genetics, previous medical history, psychological status and history, motivation to follow physical therapy advice and various other factors.

It is impossible to give a 100% complete accurate diagnosis and prognosis without a thorough physical examination and likewise the advice given cannot be deemed fully accurate in the absence of this examination from a vestibular specialist.

Significant injury risk is possible if you do not follow due diligence and seek suitable professional advice about your injury. No guarantees of specific results are expressly made or implied in this blog.

References

1) Jönsson R, Sixt E, Landahl S, Rosenhall U. Prevalence of dizziness and vertigo in an urban elderly population. J Vestib Res. 2004;14(1):47-52.

2) Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otoaryngol Head Neck Surg. 2000;122(5):630-634.

3) Chau AT, Menant JC, Hübner PP, Lord SR, Migliaccio AA. Prevalence of Vestibular Disorder in Older People Who Experience Dizziness. Front Neurol. 2015;6(268)

4) Hornibrook J. Benign Paroxysmal Positional Vertigo (BPPV): History, Pathophysiology, Office Treatment and Future Directions. In J Otolaryngol. 2011;2011:1-13.

5) Parnes LS, McClure JA. Free-floating endolymph particles: a new operative finding during posterior semicircular canal occlusion. Laryngoscope. 1992;102(9):988-992.

6) Kao WT, Parnes LS, Chole RA. Otoconia and otolithic membrane fragments within the posterior semicircular canal in benign paroxysmal positional vertigo. Laryngoscope. 2017;127(3):709-714.

7) Hunt WT, Zimmerman EF, Hilton MP. Modifications of the Epley (canalith repositioning)manoeuvre for posterior canal benign paroxysmal positional vertigo (BPPV) (Review). Cochrane Database of Systematic Reviews. 2012;4.

8) Hilton MP, Pinder DK. The Epley(canlith repositioning) manoeuvre for benign paroxysmal positional vertigo (Review). Cochrane Database of Systematic Reviews 2014;12.

9) McDonnell MN, Millier SL. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction. Cochrane Database of Systematic Reviews. 2015;1.

10) Obermann M, Bock E, Sabev N, Lehmann N, Weber R, Gerwig M, et al. Long-term outcome of vertigo and dizziness associated disorders following treatment in specialized tertiary care: the Dizziness and Vertigo Registry (DiVeR) Study. J Neurol. 2015;262(9):2083–2091.

11) Bhattacharyya N, Gubbels SP, Swartz SR, Edlow JA, El-Kashlan H, Fife T, et al. Clinical Practice Guideline: Benign Parosysmal Positional Vertigo (Update). Otolaryngology-Head and Neck Surgery. 2017;156(3S):S1-S47.

12) Wang H, Yu D, Song N, Yin S. Delayed diagnosis and treatment of benign paroxysmal positional vertigo associated with current practice. Eur Arch Otorhinolaryngol. 2014;271:261-264.

13) Li JC, Li CJ, Epley J, et al. Cost-effective management of benign positional vertigo using canalith repositioning. Otolaryngol Head Neck Surg. 2000; 122:334-339

14) Fife D, FitzGerald JE. Do patients with benign paroxysmal positional vertigo receive prompt treatment? Analysis of waiting times and human and financial costs associated with current practice. Int J Audiol. 2005;44:50-57

15) Grill E, Strupp M, Müller M, Klaus J. Health services utilization of patients with vertigo in primary care: a retrospective cohort study. J Neurol. 2014;261:1492-1498.

16) von Brevern MN, Radtke A, Lezius F, Feldmann M, Ziese T, Lempert T, Neuhauser H. Epidemiology of benign paroxysmal positional vertigo: a population based study. J Neurol Neurosurg Psychiatry. 2007;78:710-715

17) Batuecas-Caletrio A, Trinidad-Ruiz G, Zschaeck C, del Pozo de Dios JC, de Toro Gil L, Martin-Sanchez V, et al. Benign paroxysmal positional vertigo in the elderly. Gerontology. 2013;59(5):408-412.

18) Lawson J, Johnson I, Bamiou DE, Newton JL. Benign paroxysmal positional vertigo: clinical characteristics of dizzy patients referred to a Falls and Syncope Unit. QJ Med. 2005;98(5):357-364

19) Liao WL, Chang TP, Chen HJ, Kao CH. Benign paroxysmal positional vertigo is associated with an increased risk of fracture: a population-based cohort study. J Orthop Sports Phys Ther. 2015;45(5):406-412.

20) Gananca FF, Gazzola JM, Gananca CF, Caovilla HH, Gananca MM, Cruz OL. Elderly falls associated with benign paroxysmal positional vertigo. Braz J Otorhinolaryngol. 2010;76(1):113-120.

21) Jumani K, Powell J. Benign Paroxysmal Positional Vertigo: Management and Its Impact on Falls. Annals of Otology, Rhinology & Laryngology. 2017;126(8):602-605

22) Oghalai JS, Manolidis S, Barth JL, Stewart MG, Jenkins HA. Unrecognized benign paroxysmal positional vertigo in elderly patients. Otoaryngol Head Neck Surg. 2000;122(5):630-634.

23) Lynn S, Pool A, Rose D, Brey R, Suman V. Randomized trial of the canalith repositioning procedure. Otolaryngol Head Neck Surg. 1995;113:712-720.

24) Burton MJ, Eby TL, Rosenfeld RM. Extracts from the Cochrane Library: modifications of the Epley (canalith repositioning) maneuver for posterior canal benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2012;147:407-411.

25) Geser R, Straumann D. Referral and final diagnoses of patients assessed in an academic vertigo center. Frontiers in Neurology. 2012;3(169).

26) Nunez RA, Cass SP, Furman JM. Short- and long-term outcomes of canalith repositioning for benign paroxysmal positional vertigo. Otolaryngol Head Neck Surg. 2000;122:647-652.

27) Welgampola MS, Akdal G, Halmagyi M. Neuro-otology- some recent clinical advances. J Neurol. 2017. 264:188-203.

28) Han W, Fan Z, Zhou M, Guo X, Yan W, Lu X, Chen C, Wu Y. Low 25-hydroxyvitamin D levels in postmenopausal female patients with benign paroxysmal positional vertigo. Acta Oto-Laryngologica. 2018;138:5,443-446.

29) Jeong SH, Kim JS, Shin JW, Kim S, Lee H, Lee AY, Kim JM, Jo H, Song J, Ghim Y. Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo. J Neurol. 2013;260(3):832–838.

30) Talaat HS, Kabel AMH, Khaliel LH, Abuhadied G, El-Rehem HA, El-Naga A. Reduction of recurrence rate of benign paroxysmal positional vertigo by treatment of severe vitamin D deficiency. Auris Nasus Larynx. 2016;43:237-241.

31) Wu Y, Gu C, Han W, Lu X, Chen C, Fan Z. Reduction of bone mineral density in native Chinese female idiopathic benign paroxysmal positional vertigo patients. American Journal of Otolaryngology – Head and Neck Medicine and Surgery. 2018;39:31-33.

32) D’Silva LJ, Staecker H, Lin J, Sykes KJ, Phadnis MA, McMahon TM, Connolly D, et al. Retrospective data suggests that the higher prevalence of benign parosysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension. Journal of Vestibular Research. 2015;25:233-239.

33) De Stefano A, Dispenza F, Suarez H, Perez-Fernandez N, Manrique-Huarte R, Ban JH, et al. A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo. Auris Nasus Larynx. 2014;41:31-36

Copyright 2018 Optimove Physical Therapy & Wellness, LLC.  Unauthorized use prohibited.  No portion of these materials may be reproduced in any manner whatsoever, without the express written consent of the publisher, except you may freely post a hyperlink to this webpage.  

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Matt Langford

Physical Therapist

Hi there! I'm Dr. Matt Langford. I have been working as a physical therapist in DFW for three years. My wife, our golden doodle named Birdie, and I love to spend our time going on different adventures whether it be hiking the Trinity trail or traveling to new places. I also love playing golf, pickleball, and serving at our local church in Fort Worth. My goals in life include learning more about the field of physical therapy so I can provide better care to individuals, pursuing my faith in a way that helps others know about Christ, and making as many memories as I can.

Kasondra Woodruff

Client Liaison

Kasondra is a mother and a pet lover, she loves spending time outdoors with her children and furry friends. With years of experience in client relations, her passion is ensuring that every client is heard and taken care of. As our Client Liaison, Kasondra takes pride in building strong relationships with our clients, ensuring that their needs are met and that they feel comfortable and confident throughout their time with us.

Jason Livas

Physical Therapy

Jason joined the Optimove team November 2023. He earned a Bachelor of Science in Exercise Science from the University of Texas at Arlington in 2012 followed by an Associate of Applied Science in Physical Therapy from Navarro College in 2019.
Jason’s clinical interests include neuromuscular training for healthy aging and longevity of the older adult, orthopedic rehabilitation and strength and conditioning. Jason also maintains certifications as a Certified Strength and Conditioning Specialist (CSCS) and trigger point dry needling (Cert DN).
Outside of work, Jason enjoys cooking, reading, strength training and spending time with his beautiful wife and kids.

Connie Thomason

Occupational Therapist

Connie holds a Master of Occupational Therapy from Texas Woman’s University (1997) and boasts over 26 years of experience as an Occupational Therapist. Her expertise lies primarily in neurological rehabilitation within a hospital-based outpatient setting. Throughout her career, Connie has worked across various healthcare settings including Acute, SubAcute, Skilled Nursing, and In-Patient Rehab.
Her specialization in Vestibular Rehabilitation since 2005 has equipped her to effectively treat a wide array of conditions, including BPPV, Vestibular Migraine, Meniere’s Disease, acute and chronic hypofunction, Acoustic Neuroma, PPPD, balance disorders, central vestibular disorders, concussion, and Superior Canal Dehiscence.
Connie holds numerous certifications, including the 360 Neuro Health Certificate of Competency in Vestibular Rehab, Emory University Vestibular Rehabilitation Competency-Based Course, 360 Neuro Health V2FIT for concussion, Lee Silverman Voice Therapy (LSVT) BIG for Parkinson’s patients, Neuro Developmental Treatment (NDT) for stroke patients, and NASM Corrective Exercise certification. She is also certified in the Montreal Cognitive Assessment (MoCA).
Active in professional communities, Connie is a member of the American Occupational Therapy Association and the Vestibular Disorders Association.
Outside of her professional endeavors, Connie enjoys spending time with her husband of 30 years, along with their two rescued bulldogs. Her hobbies include riding motorcycles, traveling, running, painting, and reading extensively about health, wellness, and vestibular research.

Andy Altmoyer

Operations Manager

Andy grew up as part of a military family, living all over the country and abroad. He is so glad to have finally landed back in Texas. He earned a bachelor’s degree in Secondary Social Studies Education, minoring in Vocal Music and Theater from West Liberty University in West Virginia. Since then he has used his outgoing nature, education background, and organizational skills in healthcare management and operations. When he isn’t working he enjoys spending time with his family and dogs, reading Marvel comics, and cooking.
During Andy’s first venture into healthcare, while living in Ohio, he worked for a practice focused on Orthopedics where he spent time managing their Physical Therapy front desk across multiple locations as well as being a group fitness instructor for seniors, folks with special needs, and those who have had total join replacements. It’s here that he realized his deep love of helping people navigate the healthcare system and connecting them with those can meet their mobility needs.
Sad to leave that company after over 7 years, Andy and his family moved to Dallas where Andy spent 3 years as Operations Manager for a large Neurology practice. He continued helping people connect with top tier healthcare providers, navigating the pandemic, and moving the practice’s location in stride. It was during this time that Andy met Dr. Guild. The Optimove Team became a favored referral source for some of the physicians on staff and Andy got to work with their team closely as they coordinated care for the patients.
This collaboration led to Andy joining the Optimove Team in August of 2021. Andy has a unique blend of experiences not only professionally but personally as well. He has been able to assist so many people reach the correct providers to have their needs met and provides valuable insight to the workings of the healthcare system at large and how to make it work better for our clients. This also comes from helping his mother navigate worker’s compensation and disability as well as assisting his family setting up his grandparents with memory care, assisted living, physical therapy, and other services. Andy has often been quoted as saying, “I may not be the one laying the healing hands but connecting folks to the right people who can help them makes me feel like I’m a part of something great and makes me feel good.”
Andy would like to be a part of your journey towards independence and wellness. He loves getting to know our clients and being one of their biggest cheerleaders throughout their journeys. Give him a call and take the first steps to achieving your goals.

Peter Langlois

Physical Therapy

Peter keeps our clients laughing, and the whole Optimove Team as well. Hand-picked by Jeffrey from their previous rehabilitation work, when he is not being “The Joint Whisperer” and making the seemingly impossible happen, Peter is MacGyvering up some gadget for our clients to help them move better.
Peter is originally from Rhode Island. He received his bachelor’s degree from the University of Rhode Island where his first career was as a ship captain, where he travelled the world and experienced many different cultures. Peter later developed a passion for physical therapy from his running career as a long distance runner doing marathons and ultramarathons. This led him to switch careers as he wanted to learn more about injury prevention and rehab. Peter has worked in various facilities over the last 8 years as a therapist throughout the metroplex including skilled nursing, outpatient orthopedics, and home health. He now enjoys working with our clients on various movement disorders, gait mechanics and balance issues. In his spare time Peter enjoys chopping wood and going for long trail runs with his family.

Jeffrey R. Guild, PT, DPT, (Former CSCS)

Owner, Therapist

When Dr. Jeffrey Guild is not working as business owner and clinician, he is dedicating time to his wife and children. His other hobbies include working out (Mainly in the weight room), music (Listening, playing, & researching), history, science, and studying business and successful people.
Jeffrey is originally from Bettendorf, Iowa and went to The University of Iowa and graduated with a bachelor’s degree in Health Promotion (Minors in Integrative Physiology & Psychology). He also worked as a Strength & Conditioning intern with The University of Iowa for 3 years and volunteered in cardiac rehabilitation at The University of Iowa Hospitals & Clinics. Upon arriving to Texas, he interned at the Cooper Aerobics Center.
Jeffrey’s first career was as a strength & conditioning professional and personal trainer. Even in the fitness industry he specialized in working with people who were older and with physical limitations. His particular emphasis as a personal trainer was identifying basic movement problems to prevent injuries BEFORE the training started, which gave him a greater understanding about human movement and was a natural segway towards Physical Therapy.
Jeffrey graduated with a Doctorate Degree in Physical Therapy at The University of North Texas Health Science Center in Fort Worth in 2013. He received the Dean’s research Award for the Allied Health Department and got published in multiple journals. After physical therapy school he started his career by receiving mentoring for over a year working in a vestibular/neurological specialty outpatient practice. Since then he has worked in a number of areas of physical therapy including inpatient rehabilitation, acute care, skilled nursing, memory care, and even pediatrics. In 2018 he started his own practice with the name “Optimove” with the emphasis on a combination of “optimal movement” and “optimism.”