Dizziness and fall risk · St. Louis
Dizziness, balance and falls
Dizziness, poor balance and falls usually trace to a measurable failure in one of three places: the inner ear, sensation from the feet, or blood pressure control when you stand. Knowing which one tells you which fix applies.
Being unsteady is not an inevitable part of getting older. It is a measurable failure of specific systems, and most of those systems can be assessed in under half an hour.
How common are balance problems and falls?
In a national survey of US adults aged 40 and older, 35.4% — about 69 million people — had vestibular dysfunction detectable on a simple standing-balance test. The odds rose with age and were 70% higher among people with diabetes. Among those who also reported dizziness, the odds of falling were twelve times higher.
Falls are not a minor outcome. In 2020, 27.6% of US adults aged 65 and over — 14 million people — reported falling in the previous year, and in 2021 there were 38,742 deaths from unintentional falls in that age group.
Why does balance fail?
Standing upright is a three-system problem: the inner ear reports head position and movement, the eyes report where the world is, and sensation from the feet and joints reports where the body is. Any one of the three can fail, and the others compensate until they cannot.
Inner ear
Vestibular dysfunction — measured with vestibular and balance testing.
Sensation from the feet
Small-fiber and large-fiber loss — measured with sudomotor testing and clinical sensory examination.
Blood pressure control
A drop in blood pressure on standing — measured with autonomic testing.
That third one is the reason balance sits inside a cardiometabolic assessment rather than in a separate specialty. A person who feels unsteady because their blood pressure drops on standing has an autonomic problem, not an inner-ear problem, and vestibular rehabilitation will not fix it.
What does a balance and fall-risk test involve?
Eye movement recording, gaze and positional testing including the Hallpike maneuver, and a vestibular autorotation test — typically completed in under 25 minutes. Combined with the autonomic and sensory measurements from the rest of the visit, it produces an objective fall-risk picture rather than a subjective one.
Why is memory tested along with balance?
Attention and executive function are part of how a person recovers from a stumble, which is why cognitive screening is paired with balance testing rather than treated as an unrelated topic.
If you are a clinician: the same subject written for the person ordering the test is at cognitive assessment and fall prevention.
Talk to someone about testing
Tell us what you are trying to find out and we will explain which Measura assessments answer that question, what each one involves, and how the results are reviewed with a clinician.
4477 Woodson Rd, Suite 201, St. Louis, MO 63134. Monday to Friday, 9:00 a.m. to 5:00 p.m. Please do not send symptoms, diagnoses or images through a web form — a website form is not a secure medical channel. Send your name and number and we will call you back.
Frequently asked questions
I get dizzy when I stand up. Is that my ears?
Often it is not — a blood pressure drop on standing produces the same sensation and has a different fix. Dizziness and the risk of falling.
I have not fallen. Should I still be tested?
Yes, particularly over 70. Measurable vestibular dysfunction is common well before anyone falls. Why measure before the first fall.
Does the testing make me dizzy?
Positional testing can briefly provoke the sensation you already get — that is how it identifies the cause. It settles quickly. What the appointment feels like.
Could my medication be the reason?
Frequently, and medication review is one of the highest-yield parts of fall prevention. Bring the full list.
Is dizziness a warning sign?
It can be. In a national survey of US adults aged 40 and older, people who had vestibular dysfunction on a simple standing-balance test and also reported dizziness had twelve times higher odds of falling. Being unsteady is not an inevitable part of getting older. It points to a measurable failure in a specific system, and most of those systems can be checked in under half an hour.
What are the main causes of dizziness and poor balance?
Usually a failure in one of three places. The inner ear reports head position and movement, sensation from the feet and joints reports where your body is, and blood pressure control has to hold steady when you stand. Any one can fail while the others compensate, until they cannot. Medications are also a frequent contributor, so bring the full list.
What stops dizziness?
The fix depends on the cause, which is why the cause gets measured first. An inner-ear problem, lost sensation in the feet and a blood pressure drop on standing can all feel alike. Vestibular rehabilitation is aimed at the inner ear and will not fix a blood pressure drop, and a medication review is one of the highest-yield parts of fall prevention.
References
- Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001–2004. Archives of Internal Medicine. 2009;169(10):938–944. doi:10.1001/archinternmed.2009.66
- Kakara R, Bergen G, Burns E, Stevens M. Nonfatal and Fatal Falls Among Adults Aged ≥65 Years — United States, 2020–2021. MMWR Morbidity and Mortality Weekly Report. 2023;72(35):938–943. doi:10.15585/mmwr.mm7235a1
Medically reviewed by Dr. Gurpreet Singh Padda, MD, MBA, MHP, medical director of Measura. Last reviewed .