This older patient is experiencing disequilibrium, or unsteadiness with walking or standing, and is likely to benefit from physical therapy. She is lightheaded and dizzy without presyncope, syncope, orthostasis, or vertigo. Disequilibrium frequently presents in frail elderly patients who have multiple sensory deficits (such as impaired visual or auditory acuity and impaired proprioception), motor weakness, joint pain, psychiatric disease, orthostasis, medication side effects, or neuropathic and cerebellar diseases affecting balance and gait. Frequently more than one cause can be identified in a specific patient. Multidisciplinary efforts (physical therapy, visual and auditory screening followed by correction of impairment, and mobility aids that stabilize ambulation) can produce improvement in functional status.

A CT scan of the head is unlikely to be helpful in delineating a cause of dizziness as this patient's neurologic examination is normal and she has no history of falls or head trauma that would put her at risk for a subdural hematoma. CT scans of the head have limited ability to image the posterior fossa and cerebellum, so if a central cause of this patient's symptoms were suspected, MRI of the brain would be the preferred test.

The diagnostic yield of 24- to 48-hour ambulatory electrocardiographic monitoring in uncovering significant cardiac arrhythmias responsible for generalized weakness and dizziness would be low in this patient without a history or symptoms of cardiac disease.

This patient should be evaluated by a physical therapist for the most appropriate gait aid. She currently is unable to use a cane effectively, and she likely will need further evaluation and training in using the best assistive device. A walker should not be provided without additional evaluation.