Why do the elderly start to shake? Understanding the causes of tremors in older adults

According to the National Institute of Neurological Disorders and Stroke, millions of Americans have essential tremor, a common cause of shaking. Understanding why do the elderly start to shake is the first step toward effective management and proper care, as tremors can stem from various underlying medical issues or lifestyle factors.

Quick Summary

Involuntary shaking in the elderly can be caused by conditions like essential tremor, Parkinson's disease, or medication side effects, as well as lifestyle factors such as stress or caffeine. While not all shaking is a sign of a serious illness, a medical evaluation is crucial to determine the specific cause and an appropriate course of action.

Key Points

• Not a Normal Part of Aging: Tremors in the elderly are not an inevitable sign of getting older but often indicate an underlying medical issue or lifestyle factor.

• Essential Tremor vs. Parkinson's: Essential tremor (ET) is an 'action tremor' that occurs during movement, while Parkinson's disease (PD) involves a 'resting tremor' that occurs when the body is still.

• Medications Can Be the Cause: Many common medications, including some antidepressants and asthma drugs, can cause or worsen tremors as a side effect.

• Manage Stress and Stimulants: Factors like high anxiety, caffeine, and alcohol can trigger or increase the severity of shaking, so managing these can help.

• Seek Medical Evaluation: Any new, persistent, or worsening tremors, especially if accompanied by other neurological symptoms, should be evaluated by a doctor to determine the root cause.

Common Causes of Tremors in Older Adults

Tremors, or involuntary rhythmic shaking, are more common with age but are not a normal part of aging itself. Instead, they are often a symptom of an underlying condition. Identifying the type of tremor and its specific characteristics is key to understanding its root cause.

Essential Tremor: A Common Neurological Disorder

Essential tremor (ET) is one of the most prevalent movement disorders, affecting millions of people globally. Unlike Parkinson's disease, which often involves resting tremors, ET typically causes an 'action tremor.' This means the shaking occurs during voluntary movement, such as holding a cup, writing, or using utensils.

• Hereditary Link: Many cases have a genetic component, often running in families.
• Progression: Symptoms often start mildly but can progress and worsen over time, though it is not considered life-threatening.
• Affected Areas: While most noticeable in the hands, ET can also affect the head, voice, and other body parts.

Parkinson's Disease: A Progressive Neurological Condition

Parkinson's disease (PD) is another significant cause of tremors in older adults. The hallmark of PD tremors is that they typically occur at rest—for example, when a person's hand is resting in their lap. This is known as a resting tremor and is often described as 'pill-rolling'.

• Key Distinction: The tremor often starts on one side of the body and may eventually spread to the other, though it remains more pronounced on the initial side.
• Other Symptoms: Unlike ET, PD involves other symptoms, such as muscle stiffness (rigidity), slowed movement (bradykinesia), and balance problems.
• Neurotransmitter Loss: PD is associated with the loss of dopamine-producing nerve cells in the brain, affecting movement control.

Medical Conditions Beyond Essential Tremor and Parkinson's

Beyond these two primary causes, several other medical issues can lead to tremors in the elderly. A thorough medical evaluation is necessary to rule out or diagnose these conditions.

• Hyperthyroidism: An overactive thyroid gland can increase metabolism and trigger a fine, rapid tremor.
• Cerebellar Stroke: Damage to the cerebellum, the part of the brain that controls balance and coordination, can cause tremors.
• Vitamin Deficiencies: Low levels of certain B vitamins, particularly B12, can impact nerve health and lead to neurological symptoms, including tremors.
• Liver or Kidney Failure: These conditions can cause metabolic imbalances that affect the nervous system and trigger a type of tremor.

The Impact of Medications and Lifestyle Factors

Pharmacological and lifestyle factors can also play a role in tremors. For many older adults, a review of their current medications is a critical step in a tremor diagnosis.

• Medication Side Effects: A wide range of medications can cause or worsen tremors. This includes some antidepressants (SSRIs), asthma medicines, and certain anti-seizure drugs. Dosing changes or stopping the medication under a doctor's guidance can often resolve the issue.
• Stress and Anxiety: High levels of stress and anxiety can trigger or exacerbate tremors, known as psychogenic tremors. The body's 'fight or flight' response releases hormones that can cause muscle tension and shaking.
• Substance Use: Excessive caffeine intake can act as a stimulant, while alcohol withdrawal can also induce tremors.
• Sleep Deprivation and Fatigue: Being overtired can cause temporary shaking in otherwise healthy individuals and worsen existing tremors.

Comparing Essential Tremor vs. Parkinson's Disease

Understanding the differences between these two common causes of tremors is crucial for accurate diagnosis and treatment. The table below highlights the key distinctions:

Feature	Essential Tremor (ET)	Parkinson's Disease (PD)
Timing of Tremor	Most noticeable during voluntary movement (action tremor).	Most noticeable at rest (resting tremor).
Body Parts Affected	Often affects both hands, head, voice, and face.	Usually starts on one side of the body, often in a hand or leg.
Associated Symptoms	Primarily a tremor, though it can interfere with daily tasks.	Accompanied by stiffness, slowed movement, and balance issues.
Progression	Gradually worsens over time; not life-threatening.	Progressive and degenerative neurological condition.
Inheritance	Often inherited (familial tremor).	Less often inherited; linked to environmental and genetic factors.

Diagnosis and Management Options

Anyone experiencing persistent or worsening tremors should consult a healthcare provider for a proper diagnosis. A doctor will typically perform a physical exam, review medical history, and may order blood tests or imaging to determine the cause.

• Medication Adjustments: If a drug is the culprit, the doctor may adjust the dose or switch medications to alleviate symptoms.
• Prescription Medications: Medications such as beta-blockers (propranolol) or anti-seizure drugs (primidone) can help manage essential tremor.
• Lifestyle Modifications: Simple changes can help. Reducing caffeine and alcohol, getting sufficient sleep, and practicing relaxation techniques like meditation can reduce tremor severity.
• Occupational Therapy: Therapists can provide strategies and adaptive devices, such as weighted utensils or special pens, to help with daily tasks.
• Advanced Treatments: For severe, debilitating tremors that don't respond to medication, procedures like Deep Brain Stimulation (DBS) or Focused Ultrasound may be considered.

When to Seek Medical Attention

While mild, occasional tremors may not be a concern, it's crucial to seek medical help if the shaking interferes with daily activities or is accompanied by other symptoms like stiffness, weakness, or trouble walking. A medical professional can provide a correct diagnosis and create an effective treatment plan.

For more information on movement disorders and related conditions, consult the National Institute of Neurological Disorders and Stroke.

Conclusion

Shaking in older adults is not an inevitable part of aging but rather a sign that something may need medical attention. The causes range from common neurological conditions like essential tremor and Parkinson's disease to medication side effects and lifestyle factors. By understanding the potential reasons behind involuntary shaking and seeking appropriate medical guidance, older adults can find effective ways to manage symptoms and maintain their quality of life. An accurate diagnosis is the essential first step towards finding a solution and peace of mind.

Frequently Asked Questions

Is all shaking in the elderly caused by Parkinson's disease?

No, not all shaking is caused by Parkinson's disease. While PD is a well-known cause, essential tremor is a much more common cause of tremors in older adults. Other factors, including medication side effects, stress, and underlying health conditions, can also be responsible.

What is the difference between an essential tremor and a Parkinson's tremor?

The key difference is when the tremor occurs. An essential tremor is typically an 'action tremor,' meaning it happens during voluntary movement. A Parkinson's tremor is a 'resting tremor,' which is most noticeable when the affected body part is at rest and motionless.

Can diet or vitamin deficiencies cause shaking?

Yes, nutritional factors can play a role. Deficiencies in certain vitamins, particularly Vitamin B12, can affect nerve function and contribute to tremors. An imbalanced diet or excessive intake of stimulants like caffeine can also worsen symptoms.

How can I tell if a medication is causing tremors?

Medication-induced tremors typically appear after a new drug is started or a dosage is increased. If you notice a new tremor that correlates with a medication change, consult your doctor. Never stop taking a prescribed medication without medical guidance.

Can stress and anxiety make shaking worse?

Yes, stress and anxiety can significantly worsen existing tremors or trigger new ones. Emotional distress activates the body's 'fight or flight' response, which can cause muscle tension and shaking. Relaxation techniques can be helpful in managing this.

Are there simple things that can help manage mild shaking?

For mild cases, lifestyle adjustments can be beneficial. These include reducing caffeine and alcohol intake, ensuring adequate sleep, managing stress with relaxation exercises, and using adaptive devices like weighted utensils to make tasks easier.

When should I see a doctor for shaking?

You should see a doctor if the shaking is new, persistent, or interferes with daily activities. A medical evaluation is also recommended if the tremors are accompanied by other symptoms, such as stiffness, difficulty walking, or changes in balance.