Is Dizziness the Hidden Cause of Frailty?
Written by Justine Hamlin, PT, DPT
Understanding Frailty and How to Stay Ahead of It
As we get older, it's natural for our bodies to change, but sometimes those changes can lead to a condition known as frailty. Frailty can increase the risk of falls, fractures, low energy levels, and make it harder to enjoy the activities that bring meaning to our lives. It’s also linked to poorer overall health outcomes.
Frailty can be identified using the Fried criteria, which includes unintentional weight loss (more than 5% of body weight in the past year), feeling tired or exhausted frequently, muscle weakness, slow walking speed (taking more than 7 seconds to walk 15 feet), and low levels of physical activity.1
What Causes Frailty?
A major factor is loss of muscle mass and reduced physical activity. New research from Pauwels et. al suggests that another, often overlooked condition might play a role: Benign Paroxysmal Positional Vertigo (BPPV).2 This vestibular (inner ear) disorder can cause dizziness, vertigo, balance issues, and nausea, leading many older adults to limit their movement and physical activity. This reduced activity can set off a cycle of weakness, fatigue, and further decline in mobility. A study from Donovan et. al found that over half of people who fall have a vestibular disorder.3
The good news? BPPV is treatable. It’s caused by tiny calcium crystals (called otoconia) that become dislodged in the inner ear. A trained physical therapist can often resolve the issue using simple repositioning maneuvers. In fact, about 84% of people have complete resolution of symptoms after just one maneuver, and most find relief within two visits.4
Am I Becoming Frail?
There are a couple of simple tests you can try at home to check for signs of frailty:
1. Walking Speed – Timed Up and Go (TUG) Test
This test checks your walking speed:
Set up a chair and a line 10’ away
Stand up from the chair, walk to the line, turn around at the line, walk back to the chair and sit down
The test ends when your buttocks touch the seat.
Use a stopwatch to measure the total time from when buttocks leave the chair, to when buttocks touch the seat
A time of greater than 13.5 seconds indicates increased fall risk in older adults
👉 Learn more about the TUG Test
2. Leg Strength – Five Times Sit-to-Stand Test
Sit with arms folded across their chest and with your back against a chair.
Stand up and sit down five times in a row, as quickly as you can. Stand up fully and try not to let your back touch the chair back between each repetition. Do not use the back of your legs against the chair.
Time starts upon initiation of first standing, and stops when your buttocks touch the chair following the fifth repetition.
If individuals are unable to complete the first sit to stand independently, without use of arms, the test is terminated.
A time greater than 12 seconds indicates fall risk
👉 More about the Five Times Sit-to-Stand Test
If you're concerned about frailty, dizziness, or balance, talk to our specialists at Audia Physical Therapy. With the right support and interventions, you can maintain your independence and stay active longer. Learn how balance therapy and vestibular rehabilitation can help. Contact Us
References
Fried LP, Tangen CM, Walston J, et al.; Cardiovascular Health Study Collaborative Research Group. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M156.
Pauwels S, Lemkens N, Lemmens W, Meijer K, Meyns P, Berg RVD, Spildooren J. The Importance of Frailty in Older Adults With Benign Paroxysmal Positioning Vertigo. J Neurol Phys Ther. 2025 Apr 1;49(2):99-107. doi: 10.1097/NPT.0000000000000495. Epub 2024 Nov 22. PMID: 39805124.
Donovan J, De Silva L, Cox H, Palmer G, Semciw AI. Vestibular dysfunction in people who fall: A systematic review and meta-analysis of prevalence and associated factors. Clin Rehabil. 2023 Sep;37(9):1229-1247. doi: 10.1177/02692155231162423. Epub 2023 Apr 10. PMID: 37036433.
Chen Y, Zhuang J, Zhang L, Li Y, Jin Z, Zhao Z, Zhao Y, Zhou H. Short-term efficacy of Semont maneuver for benign paroxysmal positional vertigo: a double-blind randomized trial. Otol Neurotol. 2012 Sep;33(7):1127-30. doi: 10.1097/MAO.0b013e31826352ca. PMID: 22892804.