Dizziness is a common clinical symptom rather than a diagnosis of disease. Dizziness is a common clinical complaint in the elderly, and its onset causes more secondary damage than the discomfort of dizziness itself. Most elderly people have varying degrees of osteoporosis, and unpredictable dizziness can lead to falls or even fractures, such as femoral neck fractures that require long-term bed rest, or may cause bedsores, venous thrombosis, pneumonia, etc., all of which are fatal; secondly, some related diseases cause dizziness accompanied by severe nausea and vomiting, resulting in electrolyte disturbances that also endanger the health of the elderly. As the condition of elderly patients is complex, it is necessary to understand the classification and clinical characteristics of dizziness in the face of the diagnosis and treatment of dizziness in the elderly. First of all, we should differentiate between dizziness and vertigo. Dizziness broadly refers to the alteration of balance sensation or balance disorder, while vertigo refers to the dysfunction of the balance system (visual, proprioceptive, vestibular system) leading to spatial orientation disorder, and dizziness includes vertigo, imbalance dizziness, mental status instability and pre-syncope. In emergency medicine, emergency triage of dizziness in the elderly is particularly important. If patients with otogenic vertigo are referred to neurology, patients miss the opportunity for timely recovery, and if patients with central dizziness are left in otorhinolaryngology or other related departments, patients miss the opportunity to save their lives in a timely manner. In terms of symptom identification, the patient’s description is most characteristic. Patients with otogenic vertigo present with sensation of peripheral objects rotating around themselves when opening their eyes and sensation of their own rotation when closing their eyes, along with autonomic symptoms such as nausea, vomiting, pallor, sweating, etc. Some patients are accompanied by sensation of stool and urine. Emergency cranial CT can help rule out cerebral hemorrhage, while diffusion-weighted imaging with cranial MRI can help rule out cerebellar lacunar infarction. Cerebellar lacunar infarction is an emergency and should be thrombolized within 6 h. The risk of cerebral edema secondary to brain herniation is greater than ischemia itself. After the initial emergency triage, patients are usually treated symptomatically and further examination is done to clarify the diagnosis after their condition is stabilized to avoid recurrence of the disease. Vertigo is divided into two categories: central vertigo and peripheral vertigo, which are diagnosed locally by vertigo characteristics in non-emergency departments. Peripheral vertigo is true vertigo with obvious autonomic symptoms, nystagmus of horizontal rotation, consistent with the degree of vertigo, no neurological signs, diminished or absent vestibular function test results, and positional nystagmus type I. Central vertigo is pseudo or true vertigo with fewer or no obvious autonomic symptoms, nystagmus of a single horizontal, rotational or vertical nature, and vertigo may still persist in remission with signs of brainstem, cerebellar and parietal-temporal lobe damage, and positional nystagmus type II. In addition, preliminary judgments are made by the duration of dizziness in relation to the disease. Patients with benign paroxysmal positional vertigo lasting a few seconds and those with a duration of several minutes to half an hour may have transient ischemic attacks, migrainous vertigo, or Meniere’s disease. Patients with longer duration need to be alert for vagal pathology or brainstem or cerebellar infarction. Second, dizziness is classified for relevant examinations The common causes of dizziness in the elderly are central nervous system pathology, ear, neck and cardiovascular and cerebrovascular diseases and anemia, colds, etc. Therefore, dizziness is classified as cerebral, cardiac, vascular, drug, cervical, otogenic and psychogenic dizziness. The diagnostic process of dizziness in the elderly needs to start with detailed questioning and recording of medical and medication history, a thorough physical examination and necessary ancillary tests to help clarify the diagnosis, and for patients with complex conditions, complementary ancillary tests with differential diagnostic value. Ancillary examinations for dizziness include audiology, vestibular function, fundus, electrocardiogram, imaging, etc. The diseases related to dizziness will be classified first through the related disease diagnostic points together with audiology, positional vertigo and imaging examinations. For otogenic dizziness, benign paroxysmal positional vertigo, Ménière’s disease and vestibular neuritis can be seen in the elderly and occupy the top 3 positions of peripheral vertigo respectively. The diagnosis of Ménière’s disease is characterized by symptom diagnosis and exclusion diagnosis, when the patient has a first episode of dizziness or an atypical quadruple symptom, and when a second episode of dizziness with other triple typical symptoms and exclusion of other diseases can confirm the diagnosis of Ménière’s disease. In the elderly, a history of Ménière’s disease in younger age and recurrent episodes can aid in the diagnosis. Vestibular neuritis accounts for the 3rd most common form of peripheral vertigo and is self-limiting, characterized clinically by a patient with a history of recent upper respiratory viral infection presenting with dizziness and vertigo but without deafness or tinnitus. It is of interest that its natural course is sometimes combined with benign paroxysmal positional vertigo. In recent years, the incidence of benign paroxysmal positional vertigo is high, and the diagnosis is easily confirmed by a clear positional nystagmus test, and the treatment by manual repositioning is simple, effective and quick. Its clinical characteristics are vertigo with nystagmus when the patient’s head position changes by gravity, and the main points of its diagnosis are short duration of vertigo attack, mostly within 1rain; with latency, fatigue and head position change inducing typical position-induced nystagmus, and no deafness or tinnitus. The recognition of benign paroxysmal positional vertigo is a process of misdiagnosis – confirmation – generalization. In the early clinical stage, benign paroxysmal positional vertigo was mostly misdiagnosed as cervical spondylosis and referred to orthopedics or transient ischemic attack and referred to neurology, but with the recognition of the disease and academic In recent years, there is a tendency to generalize benign paroxysmal positional vertigo and misdiagnose cervical spondylosis, transient ischemic attack, Meniere’s disease, and even central positional vertigo caused by cranial skull base lesions as benign paroxysmal positional vertigo, which deserves clinical attention. Other otogenic vertigo diseases need to be treated by otologists. The concept of cervical vertigo has been clinically controversial, but it is generally considered to be dizziness caused by organic or functional changes in the cervical spine and related soft tissues (joint capsule, ligaments, nerves, blood vessels, muscles, etc.), also known as Barre-Lieou syndrome. The clinical features are characterized by positional dizziness of the head and neck, which occurs when the head and neck are rotated or laterally flexed to a specific position and disappears when the position is restored. After several episodes, the patient feels fearful and consciously avoids a specific position. The patient’s neck pain is closely related to the dizziness symptoms during the course of the disease, and a history of previous neck trauma or neck disease and exclusion of other causes of dizziness is needed to differentiate the diagnosis from benign paroxysmal positional vertigo. It is worth noting that vertebral artery type cervical spondylosis is manifested by the patient’s history of sudden collapse, sudden weakness of the lower limbs and collapse when hearing the shouting review from behind, and the symptoms disappear when the head position returns after collapse, and the patient’s consciousness is clear during the attack. Cervical spine X-ray in frontal, lateral, oblique and open-mouth positions can make a preliminary determination of cervicogenic dizziness, and cervical spine computed tomography, magnetic resonance examination and further treatment require an orthopedic specialist. For vascular dizziness, the hot topic is the consensus on posterior circulation ischemia. The consensus on posterior circulation ischemia includes its etiology as atherosclerosis and mechanism as embolism; simple dizziness and vertigo are rarely posterior circulation ischemia. Dizziness and vertigo are common manifestations of posterior circulation ischemia, but the common etiology is not posterior circulation ischemia, and cervical spine osteophytes are not the main etiology of posterior circulation ischemia. In both emergency and outpatient clinics, clinical manifestations of posterior circulation ischemia need to be emphasized in elderly patients, and the main points are 6 items, namely dizziness, diplopia, dysarthria, dysphagia, ataxia, and fall episodes. In addition migrainous vertigo, blood theft syndrome and vestibular paroxysm are also considered to be and vascular factor related dizziness, which shows that for elderly patients, specialist diagnosis and treatment is needed. Chronic subjective dizziness among psychogenic dizziness has received clinical attention, with the main manifestations being persistent primary somatic symptoms, non-vertigo dizziness or subjective balance disorders for more than 3 months; the secondary manifestations are air-questioning motion discomfort and visual vertigo. Further classification: (1) psychogenic chronic subjective dizziness: primary or psychogenic; (2) neuro-otologic chronic subjective dizziness: anxiety or depression secondary to an earlier otologic condition; (3) interactive chronic subjective dizziness: previous tendency to anxiety or depression. The diagnosis of chronic subjective dizziness emphasizes consultation and screening, and can be diagnosed by vertigo questionnaire, vertigo bedside examination, vestibular examination, screening and assessment by scales, including the Dizziness Disorder Scale, the Dizziness Disorder Scale indicators (E index related to depression and F index related to anxiety) and the Hamilton Anxiety-Depression Scale, with D related to depression and A related to anxiety in the Hamilton Anxiety-Depression Scale questions. Pharmacologic dizziness among medical dizziness receives clinical attention. The elderly are characterized by multiple illnesses and medications, so when taking a medical history for geriatric dizziness, the patient’s medication history should be screened. Some drugs can cause dizziness, including aminoglycoside antibiotics, diuretics, salicylates, quinine, azelaic acid, isoniazid, phenobarbital, phenytoin sodium, etc. In addition, pharmacological dizziness includes improper use of medication during dizziness treatment, such as Meniere’s disease, including the stimulation phase, paralysis phase, central compensatory phase, recovery phase, if the long-term use of dizziness treatment during the central compensatory phase or recovery phase of Meniere’s disease vestibular If vestibular depressants are used for a long time during the central compensatory or recovery phase of Ménière’s disease, this can lead to delayed compensation and recovery, with patients exhibiting prolonged dizziness and ineffective drug therapy. Cardiogenic diseases of dizziness in the elderly include atrial fibrillation, As syndrome attacks, postural hypotension, etc. Cerebral diseases include multiple sclerosis, cerebral infarction, cerebral atrophy and brain tumors, etc. Although they account for a small percentage of the dizziness classification, they cannot be ignored, and a detailed history, careful physical examination, and appropriate ancillary tests can clarify the diagnosis.