The vestibular system in the elderly: clinical implications.

Cell loss, changes in synapse morphology, electrophysiologic alterations, and changes in the supporting microenvironment have all been noted in portions of the vestibular systems of aged animals and humans. Increased variability with age is also a prominent finding in many studies. Quantitative vestibular testing in humans has shown alterations with age as well, but decline with aging is not a prominent feature of all measures, and many reported studies are methodogically flawed. The connection between these observed aging changes and the increased incidence of dizziness and falls in the elderly is unproven, however, and clinicians should search carefully for specific disease processes in their elderly patients who present with vestibular symptoms.