In Older Patients Treated for Dizziness and Vertigo in Multimodal Rehabilitation Somatic Deficits Prevail While Anxiety Plays a Minor Role Compared to Young and Middle Aged Patients

Abstract

Objective: Many patients with dizziness and vertigo are of older age. It is still unclear which age-associated factors play a role in the treatment of dizziness and vertigo. Therefore, age-associated characteristics of patients subjected to an interdisciplinary day care approach for chronic vertigo and dizziness were analyzed.Subjects and Methods: 650 patients with chronic dizziness/vertigo subjected to a multimodal vestibular rehabilitation day care program were analyzed. Information concerning age, gender, medical diagnosis, medical consultations, technical diagnostics performed and therapy achieved before attending the clinic were collected. Furthermore, data were gathered using the Vertigo Severity Scale (VSS), Hospital Anxiety and Depression Scale (HADS), Mobility Inventory (MI), as well as the intensity of and the distress due to vertigo/dizziness using visual analog scales. As a follow-up, the VSS, HADS, MI, and the visual analog scales were collected again 6 months after attending the therapy program. Three age groups were compared to each other (<41, 41–65, and >65 years of age).Results: One-third of the patients were older than 65 years. This group had typical diagnoses with mainly organic deficits. In contrast to the dominance of mainly multifactorial, organic deficits the older patients reported less medical consultations, fewer technical diagnostics and even fewer treatments than the younger patients. The elderly scored significantly lower in total VSS, in VSS-V (vestibular-balance subscale), in VSS-A (autonomic-anxiety subscale) and in HADS-anxiety. Psychological diagnoses were clearly associated to the younger patients. 424 patients (65.2%) completed the follow-up questionnaire 6 months after attending the therapy week. The older patients revealed improvements of VSS-V and the Avoidance Alone scale of MI as well as decreased distress due to vertigo/dizziness.Conclusion: In the older patients, who took part in our vestibular rehabilitation program, mainly somatic deficits prevail while anxiety plays a minor role compared to young and middle aged patients. Older patients profited from vestibular rehabilitation especially in mobility and vestibular-balance. Therefore, vestibular rehabilitation programs for the elderly with a focus on physio- and occupational therapeutic interventions and less cognitive behavioral therapy may be reasonable.

Multimodal treatment of persistent postural–perceptual dizziness

“…The data were prospectively collected between June 2013 and March 2017 in the Center for Vertigo and Dizziness of Jena University Hospital. These data have already been analyzed to define age‐related characteristics of patients with chronic dizziness (Dietzek et al., 2018). The study was approved by the local ethics committee (ethics committee of the Friedrich‐Schiller‐University Jena, number 5426‐02/18).…”

Vestibular Neuritis in Patients Among Different Age Groups: Clinical Features and Outcomes

“…Our data also demonstrated an age-dependent decrease in the portion of psychological diagnoses in the adult patients, though the differences were not statistically significant. Dietzek et al 25 reported elderly patients suffering from dizziness scored significantly lower in HADS than the younger patients; moreover, the elderly improved 6 months after therapy especially in Mobility Inventory when alone and in Vertigo Severity Scale (vestibular-balance subscale). However, in our study, the elderly did not show greater improvement in DHI than other age groups.…”

How Healthcare Utilization Due to Dizziness and Vertigo Differs Between Older and Younger Adults

“…Many agents might contribute to the causes of dizziness than cure it in older adults ( 45 , 47 ). In addition, anxiety and depression may play a minor role in older patients with dizziness/vertigo compared with younger patients ( 22 ). Therefore, healthcare providers may assume that psychological therapy may have less beneficial effects in older than in younger patients.…”

“…Overall, 765 patients with chronic dizziness and vertigo attended a daycare multimodal treatment program ( 22 ) between June 2013 and September 2017 in the Center for Vertigo and Dizziness of Jena University Hospital. The Center for Vertigo and Dizziness is a tertiary care outpatient project consisting of neurology, ear, nose, and throat (ENT), and physiotherapy departments.…”