In 1990, Dr. G.P. Jacobson and C.W. Newman developed a tool for doctors to assess a patient’s dizziness called the Dizziness Handicap Inventory. The first version was a series of 37 different questions grouped into three different areas – functional, emotional, and physical aspects of dizziness and unsteadiness. Over time, the final version was reduced to only 25 questions.
Once dizziness occurs in an elderly person, dramatic changes can happen functionally and psychosocially. It’s these changes that need to be monitored. Once a doctor sees that a person’s condition is worsening, they can make further changes that can help the patient so that the degradation can – potentially – be reversed.
Dizziness in Seniors
If you get a group of seniors together, it’s not uncommon for dizziness to come up in conversation. It’s a common complaint.
Some sources state that about 1 of every 4 seniors older than 72 years old has dizziness. This statistic comes from a population study done in the U.S.
Dizziness is not something to pass off as unimportant. Dizzy seniors are at a higher risk of falling, and falls lead to injuries that could include a broken bone or head trauma. Bones become brittle as we age, and a broken bone could be jagged and puncture internal organs.
Another problem related to falling is that if it’s a broken hip, there is a 22% chance of dying. If there’s a fracture of the cervical vertebrae, that percentage jumps to 24.5%. Falls in the elderly are the #1 cause of hospital admissions and accidental death in older adults. This is why balance exercises are crucial as we age.
Several studies have shown that older adults with a history of dizziness and imbalance are at a higher risk of falling. And a predictor of those who will suffer is those who have vertigo and unsteadiness.
Whenever there is any medical condition that causes postural instability, dizziness is worsened. Aging by itself causes a decrease in the hair cells and neurons of the area of the brain related to balance. But dizziness and imbalance could be caused by changes in eyesight, in the neurological system, muscles that are weakening, and the sensory system such as neuropathy as well.
Progressive degeneration of the spine, a result of arthritis, may also contribute to dizziness and vertigo. What happens here is the person finds it difficult to move their head and neck. Thus the messages that go to the brain about where the head is positioned in space are incorrect, and this leads to dizziness.
What the Dizziness Handicap Inventory Tool Measures
The tool measures how your dizziness is being affected by physical, emotional, or functional areas. It is looking at how your measurement of your perception of handicap is due to the dizziness.
For example, questions on the tool can help the practitioner rule in or out the possibility that you have benign paroxysmal positional vertigo (BPPV) would include:
- Does looking up increase your problem?
- Because of your problem, do you have difficulty getting into or out of bed?
- Do quick movement of your head increase your problem?
- Does bending over increase your problem?
BPPV is the sudden sensation that you are spinning or that the inside of your head is spinning. It causes episodes of dizziness.
Here is an image of the tool and the questions posed:
Download and Use the Tool
Would you like to know some of the questions asked on this tool? Each question should be answered with an “Always,” “Sometimes,” or “No.”
Here are some of the questions:
- Does looking up increase your problem?
- Do you restrict travel for business or pleasure because of your dizziness?
- Does walking down the aisle of a supermarket increase your dizziness?
- Do you have difficulty reading because of dizziness?
- Does turning over in bed increase your problem of dizziness?
- Because of your problem, do you feel handicapped?
- Is it difficult for you to go for a walk by yourself because of dizziness?
- Does bending over increase your dizziness?
- Because of the dizziness, are you depressed?
- Does your dizziness interfere with your job or household responsibilities?
To use the Dizziness Handicap Inventory Tool, answer the questions on the tool. You can download in the link above. Then take your answers to your physician for him to interpret them for you, and to prescribe rehabilitation for you.
Scoring the Tool
The Dizziness Handicap Inventory Scale was created so doctors could clinically assess the dizziness and its impact on the person. Once dizziness is assessed, rehabilitation should be started rapidly to avoid these psycho-social complications, such as the fear of falling.
Scores greater than 10 points should be referred to balance specialists for further evaluation.
- 16-34 points (mild handicap)
- 36-54 points (moderate handicap)
- 54+ points (severe handicap)
The Dizziness Handicap Inventory shows a high correlation of reliability for the functional and emotional categories based on the scores. When the scores are high in one of these areas, there’s a pretty good chance that the dizziness is related to that category.
The rehab that is prescribed is usually based on the highest scored category. Then, during rehab the Dizziness Handicap Inventory test is repeated. If there is a change of 7% or greater in the overall score, the physician will believe that there has been a true change.