1 © 2008 Royal College of Physicians of Edinburgh How to Manage tHe ‘Dizzy ’ olDer Patient

Balance symptoms occur commonly in all age groups, but are particularly common in the elderly. They occur more typically in females than males.1 The most common reason for impaired balance in the elderly is global degeneration of the vestibular system, but benign paroxysmal positional vertigo (BPPV) is actually more common in the elderly.2 The history is the most important part of the assessment of balance patients, but it can be unreliable and inconsistent.3 Imaging, particularly magnetic resonance imaging (MRI) scans, is valuable in excluding serious central pathology. Vestibular rehabilitation is helpful in patients with reduced balance function. Drug treatment helps disordered labyrinthine function. Very few balance patients, particularly those who are elderly, benefit from surgery