Comparing lightheadedness and vertigo

Dear Dr. Roach: Why do older people tend to get lightheaded (not vertigo) and become liable to fall? What causes that, and can anything be done? I’m an 83-year-old lady afraid to trip. — A.R.

Dear A.R.: I’m glad you made a distinction between lightheadedness and vertigo. Vertigo is a sensation of movement when there isn’t one. Most commonly, it’s a sensation that the world is spinning, but sometimes the person is spinning.

Lightheadedness is different, often described as though they are going to pass out, which can sometimes happen.

Lightheadedness can happen to people at any age, although it is more common in older people. One of the main reasons for lightheadedness on standing is a relative lack of blood flow to the brain. The body has mechanisms to maintain blood flow despite the shift in the pressures required to send blood against the pull of gravity. These reflexes are a little slower in older people. I advise people to change position slowly to give the body time to adapt. From lying down, move to a sitting position for a few seconds or a minute before standing up.

If you feel lightheaded all the time, you should discuss this with your doctor. You didn’t mention medications, which is one of the most common causes. Since half of older people are taking medications that can affect blood flow and blood pressure, medications are a frequent culprit, but obviously need evaluation before they are adjusted.

There can be many other causes, including heart problems, so this is definitely something to get evaluated if it has not responded to these simple recommendations.