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disequilibrium in the elderly
A disorder characterized by an unsteady gait, generally in elderly individuals with multiple medical problems.
Etiology: (associated disorders)
1) visual impairment:
- cataracts
2) CNS disorders
a) Parkinson's disease
b) cerebellar atrophy, cerebellar infarct
c) stroke
d) pontocerebellar angle tumor: acoustic neuroma
3) vertebrobasilar insufficiency
4) peripheral neuropathy
a) diabetic polyneuropathy
b) vitamin B12 deficiency
5) degenerative joint disease of the cervical spine
6) deconditioning
7) orthostatic hypotension
8) polypharmacy [3]
Epidemiology:
- predominantly a disorder of the elderly
Clinical manifestations:
1) dizziness
2) unsteadiness
3) visual impairment may be present
4) numbness
5) weakness or incoordination of extremities
6) oscillopsia
Laboratory:
- peripheral neuropathy
a) serum vitamin B12
b) serum folate
c) serologic test for syphilis
d) thyroid function tests
Management:
1) physical therapy
- weight-bearing exercises
- resistance exercises
2) supportive devices
- eye glasses
- hearing aids
3) medication reconciliation
4) fall prevention
General
dizziness
disequilibrium
geriatric disorder; disease of old age; geriatric syndrome
References
- Saunders Manual of Medical Practice, Rakel (ed), WB Saunders,
Philadelphia, 1996, pg 1013-15
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed)
Lippincott-Raven, Philadelphia, 1998, pg 663
- Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 19.
American College of Physicians, Philadelphia 1998, 2009, 2021.
- Bruera E & Neumann CM
Management of specific symptom complexes in patients receiving
palliative care.
Canadian Medical Assoc. J (CAMJ):158:1717, 1998
PMID: 9676549
- Geriatric Review Syllabus, 7th edition
Parada JT et al (eds)
American Geriatrics Society, 2010