Expensive investigations are rarely helpful in dizzy elderly people. The cause of the dizziness can be diagnosed in most cases on the basis of a thorough clinical examination without recourse to hospital referral.

A postal questionnaire was sent to 1000 subjects aged over 65 years randomly selected from the age/sex register of five group practices, 90% of subjects returning adequate information. Thirty per cent of responders reported dizziness; 27% of these had symptoms more than once per month and 37% had symptoms which lasted longer than 1 minute. Dizziness was most commonly provoked by postural change and head and neck movement. The prevalence of dizziness increased with age and was higher in women but these differences were not statistically significant. The prevalence of symptoms occurring more than once per month was significantly greater with increasing age (p = 0.0003). Dizziness was significantly associated with angina and previous myocardial infarction (p < 0.001) and antihypertensive therapy (p < 0.05) but not with current smoking, diabetes mellitus or previous stroke.

Sway was measured by static posturography in 74 healthy subjects. Four age groups were investigated: 20–40,40–60, 60–70 and over 70 years with equal numbers of males and females in each group. Sway increased linearly with age but was not affected by gender at any age. All age groups were more dependent on proprioception than vision in the maintenance of balance, but when reliable pressoreceptor information was removed, dependence on vision increased. The relative contributions of the sensory systems to balance did not alter with advancing age. The increase in sway demonstrated with normal ageing does not appear due to altered peripheral sensibility. It is more likely that it is due to slowing of central integrative processes.