The elderly with dizziness and disequilibrium have a higher risk of falls in comparison with the elderly without dizziness or disequilibrium. We should not, therefore, overlook the complaint of dizziness and disequilibrium in the elderly as aging effects. Also, disequilibrium and dizziness in the elderly are often intractable. It may be due to some factors, which are an aging-related functional decline of the sensory and motor organs, deterioration of the postural control system through the central nervous system, and anxiety and depression due to aging: these factors result in the increased morbidity of orthostatic hypotension (OH) with age and, polypharmacy by five or more medications. The score of the functional items on the Dizziness Handicap Inventory (DHI) increased in the late elderly aged more than 80 years old in our department, resulting in a decreased level of activities of daily living, the so-called "frailty." Those elderly patients with OH showed more severe asymptomatic infarction of cerebral white matter lesions (WMLs) on MRI and most of them have been treated by five or more medications for a variety of diseases. The degree of the WNLs in the elderly patients with OH was correlated with the variance of the subjective visual vertical, which was associated with the spatial cognitional function. If the elderly patients with disequilibrium are frail, or in the prefrail stage, early intervention with vestibular exercise should be considered. When elderly patients meet the criteria for OH in the Schellong test, we should check their polypharmacy and should firstly treat them with non-pharmacologic interventions for the OH. Also, psychologic disorders, such as depression due to aging, often make the disequilibrium symptoms intractable or severe. We should initiate cooperation with other physicians, psychologists, and urologists for the treatment of the elderly with intractable disequilibrium. In conclusion, a holistic treatment approach is necessary for the elderly with intractable disequilibrium.
