Dealing with the Dizzy Elderly – Presbyvestibulopathy

In most European countries and in Japan and North America, the amount of elderly is strongly increasing. In 2050 one expects there to be 2 billion people of more than 60y of age. Already there are more than 30% over the age of 60 in Japan and more countries will follow.

As the population ages, more individuals risk diseases, incapabilities and dementia. Reduced balance and the accompanying risk for falls will be inevitable. As balance is dependent on both vestibular, visual and proprioceptive cues, central nervous integration and planning as well as muscle strength there are several possible way of ageing to decrease the ability to stand and walk. But the system as such also has redundant features. The physcians of different specialties, not least the otolaryngologists, can and should help out in defining deficits and remedy disorders affecting several of those areas. Falls in the elderly constitute a socio-medical challenge.. Vestibular loss or decreased function should be of utmost importance and some of our recent figures corroborates that. Falls in the older elderly seems to be connected to turning, changing the position even more than fall over objects. This also suggest an importance of balance function. At present there is work done to define vestibular loss in the elderly and to suggest a definition of old age deficits, presbyvestibulopathy.

What can be done? Preventing falls, reducing impact of falls and or training the balance system. Recently there have also been suggestions of vestibular implants in bilaterally loss patients, although this seems feasible only in selected cases. We and others have been able to demonstrate that additivity and training remains to be used in higher age, suggesting the benefits of training the balance.

Several approaches have been tried for developing a balance intervention schedule. Generally, these programs have been requiring resources and hours of weekly training. We have suggested and now shown the effect of a comprised, balance-strength-vestibular program the BEEP (Balance Enhancing Exercise Program), that in pilot studies seems to be effective in pilot studies. Such approaches seems to be necessary in the future.