(p. 1177) Dizziness and vertigo 

Dizziness is one of the commonest symptoms described by older adults, particularly women, and is associated with reduced quality of life, functional decline, and falls. The term dizziness is used by patients to describe a variety of symptoms, including a hallucination of movement (vertigo), light-headedness, and a true appreciation of unsteadiness associated with gait disorders. Although there are age-related decrements in the somatosensory, visual, vestibular, and motor systems, dizziness should not be regarded as part of normal ageing. Diagnosis can usually be reached without specialist investigations, through focused history taking and bedside clinical assessment, including careful examination of eye movements and the Dix-Hallpike test. The underlying cause may be in one or several physiological systems and this will guide treatment plans. Benign paroxysmal positional vertigo (BPPV) and neuritis are more common than Meniere’s. The presence of red flag symptoms or signs suggesting central vestibular disease will require further imaging.