A three-group comparison of acute-onset dizzy, long-term dizzy and non-dizzy older patients in primary care

Kruschinski, Carsten; Sczepanek, Julia; Wiese, Birgitt; Breull, A.; Junius-Walker, Ulrike; Hummers-Pradier, Eva

doi:10.1007/bf03337755

Cited by 7 publications

(9 citation statements)

References 25 publications

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“…Studies of other MDC for patients with dizziness demonstrate a similar pattern of demographic characteristics, including a predominance of female patients and patients aged 50 years and older [7, 14–16]. In the RAD clinic, we found that approximately one-third of patients were 71 years or older, which is consistent with the typical age of acutely dizzy patients in an emergency setting [17, 18].…”

Section: Discussionsupporting

confidence: 77%

A retrospective analysis of two tertiary care dizziness clinics: a multidisciplinary chronic dizziness clinic and an acute dizziness clinic

Staibano

Lelli

Tse

2019

J of Otolaryngol - Head & Neck Surg

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BackgroundVertigo remains a diagnostic challenge for primary care, emergency, and specialist physicians. Multidisciplinary clinics are increasingly being employed to diagnose and manage patients with dizziness. We describe, for the first time in Canada, the clinical characteristics of patients presenting with chronic and acute dizziness to both a multidisciplinary chronic dizziness clinic (MDC) and a rapid access dizziness (RAD) clinic at The Ottawa Hospital (TOH).MethodsWe performed a retrospective review of all patients presenting to the MDC and RAD clinics at TOH from July 2015 to August 2017.ResultsOverall, 211 patients (median age: 61 years old) presented to the RAD clinic and 292 patients (median age: 55 years old) presented to the MDC. In the RAD clinic, 63% of patients had peripheral dizziness, of which 55% had BPPV, and only one patient had functional dizziness. Interestingly, only 25% of RAD diagnoses were concordant with emergency department diagnoses; moreover, only 33% of RAD patients had HiNTS completed, while 44% had CT scans, of which only one scan had an abnormal finding. Prior to assessment, all patients in the MDC had an unclear cause of dizziness. 28% of patients had vestibular dizziness and 21% had functional dizziness, of which 43% had persistent postural perceptual dizziness. Moreover, 12% of patients with functional dizziness also suffered from comorbid severe anxiety and depression.ConclusionsDizziness is a heterogeneous disorder that necessitates multidisciplinary care, and clinics targeting both the acute and chronic setting can improve diagnostic accuracy, ensure appropriate diagnostic testing, and facilitate effective care plans for patients with dizziness.

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Section: Discussionsupporting

confidence: 77%

A retrospective analysis of two tertiary care dizziness clinics: a multidisciplinary chronic dizziness clinic and an acute dizziness clinic

Staibano

Lelli

Tse

2019

J of Otolaryngol - Head & Neck Surg

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“…Eleven full texts were excluded because they did not meet inclusion criteria, leaving 16 publications for qualitative review. Of these 16 publications, two reported results from the same cohort study from the Netherlands [ 17 , 18 ], and two reported results from the same cohort study from Germany [ 19 , 20 ]. We decided to include all four publications into the qualitative review because they reported different aspects; two gave results of the baseline survey [ 18 , 19 ], two gave results of the follow-up [ 17 , 20 ].…”

Section: Resultsmentioning

confidence: 99%

“…Most frequently reported outcome was dizziness-specific functioning as operationalized by the Dizziness Handicap Inventory (DHI) [ 29 ] or the Vestibular Handicap Questionnaire (VHQ) [ 17 – 20 , 22 , 27 , 28 , 30 ]. Four studies examined generic health-related quality of life using four different measures [ 2 , 19 , 20 , 27 , 28 ]. Two studies reported vertigo-related symptoms using the Vertigo Symptom Scale (VSS) [ 27 , 28 ].…”

Section: Results Of Individual Studiesmentioning

confidence: 99%

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Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review

2016

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Vertigo and dizziness are frequent complaints in primary care that lead to extensive health care utilization. The objective of this systematic review was to examine health care of patients with vertigo and dizziness in primary care settings. Specifically, we wanted to characterize health care utilization, therapeutic and referral behaviour and to examine the outcomes associated with this. A search of the MEDLINE and EMBASE databases was carried out in May 2015 using the search terms ‘vertigo’ or ‘dizziness’ or ‘vestibular and primary care’ to identify suitable studies. We included all studies that were published in the last 10 years in English with the primary diagnoses of vertigo, dizziness and/or vestibular disease. We excluded drug evaluation studies and reports of adverse drug reactions. Data were extracted and appraised by two independent reviewers; 16 studies with a total of 2828 patients were included. Mean age of patients ranged from 45 to 79 with five studies in older adults aged 65 or older. There were considerable variations in diagnostic criteria, referral and therapy while the included studies failed to show significant improvement of patient-reported outcomes. Studies are needed to investigate current practice of care across countries and health systems in a systematic way and to test primary care-based education and training interventions that improve outcomes.

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“…Indeed, many patients continue to experience symptoms after receiving a diagnosis 10. This is an ominous prognosis for women as their risk of chronic dizziness is double that of males 11. Colledge and colleagues emphasise the importance of improving management in older since the causative conditions are controlled symptomatically rather than cured 12…”

Section: Discussionmentioning

confidence: 99%

Still dizzy after all these years: a 90-year-old woman with a 54-year history of dizziness

Smirnova

Bell²,

Tracy³

et al. 2011

Case Reports

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SummaryThis report presents the case of a 90-year-old female with a 54-year history of dizziness, which has been exhaustively investigated. Over the years, the patient made 59 visits to her family doctor and 18 visits to various specialists, as well as emergency department visits and hospitalisations. In detailing the exhaustive investigations and referrals that the patient has undergone over many years (with inconclusive results), this case illustrates the myriad challenges in diagnosing and treating chronic dizziness in the older. The authors suggest that, in complex cases characterised by multimorbidity and polypharmacy, a function-oriented approach is indicated. In place of the conventional 'diagnose and treat' model, a functional approach to ongoing care emphasises the symptom management, improvement of function and quality of life. To optimise patient outcomes, an interprofessional team approach is preferred.

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A three-group comparison of acute-onset dizzy, long-term dizzy and non-dizzy older patients in primary care

Abstract: Results from our sample suggest that low systolic blood pressure is more important for dizziness in older patients than increased cardiovascular risk. Acute-onset and long-term dizzy patients were comparable in many aspects, which makes this classification less clinically important.

Cited by 7 publications

References 25 publications

A retrospective analysis of two tertiary care dizziness clinics: a multidisciplinary chronic dizziness clinic and an acute dizziness clinic

A retrospective analysis of two tertiary care dizziness clinics: a multidisciplinary chronic dizziness clinic and an acute dizziness clinic

Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review

Still dizzy after all these years: a 90-year-old woman with a 54-year history of dizziness

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