Abstract:Background: Dizziness is highly prevalent among older people and associated with many health factors. The aim of the study was to determine the prevalence of and factors related to dizziness among community-dwelling older adults in Sweden. In contrast to previous studies, the subjects with dizziness were divided into two groups, mild and substantial dizziness, according to the frequency and intensity of dizziness. Methods: A sample of 305 older persons between 75 and 90 years of age (mean age 81 years) were in… Show more
“…Selection of candidate predictors was therefore based on previous research and feasibility. 9,13,14,[20][21][22][23][24][25][26][27]33 Candidate predictors were self-reported and spanned 3 domains: demographic (6 variables), health status (28 variables), and dizziness (33 variables). Dizziness-related impairment at baseline was assessed with both the full 25-item DHI 29 and the 10-item screening version of the DHI (DHI-S).…”
Section: Candidate Predictorsmentioning
confidence: 99%
“…This identification could prompt the physician to consider targeting factors potentially contributing to dizziness in these high-risk patients, even when the cause is unclear. 9,13,[20][21][22][23][24][25][26][27] Two ongoing trials are investigating the effectiveness of a multifactorial intervention for factors contributing to dizziness in older adults. 28,45 Future results of these studies may provide more specific guidance on multifactorial therapy that is effective in reducing dizziness symptoms.…”
Section: Comparison With Existing Literaturementioning
confidence: 99%
“…9,13 As a result, primary care physicians often manage dizziness in this age-group with a wait-andsee strategy, 2 although they could also focus on targeting potential contributing factors such as multiple drug use or depressive symptoms. 9,13,[20][21][22][23][24][25][26][27] Identification of patients with an unfavorable prognosis, even those with an unknown cause of dizziness, may contribute to better care, for example, by targeting potential contributing factors to dizziness in patients with an unfavorable dizziness prognosis. 9,13,[20][21][22][23][24][25][26][27] Only a single study has presented a prediction model to assess dizziness prognosis in older patients.…”
Section: Introductionmentioning
confidence: 99%
“…9,13,[20][21][22][23][24][25][26][27] Identification of patients with an unfavorable prognosis, even those with an unknown cause of dizziness, may contribute to better care, for example, by targeting potential contributing factors to dizziness in patients with an unfavorable dizziness prognosis. 9,13,[20][21][22][23][24][25][26][27] Only a single study has presented a prediction model to assess dizziness prognosis in older patients. 24 Yet, the researchers choose to exclude the strongest predictor, dizziness-related impairment as measured with the Dizziness Handicap Inventory (DHI), from their final prediction model because the score does not indicate causal mechanisms and therefore does not provide clues for treatment.…”
We developed an easy-to-use risk score for dizziness-related impairment in primary care. The risk score, consisting of only 4 predictors, will help primary care physicians identify patients at high risk for an unfavorable course of dizziness.
“…Selection of candidate predictors was therefore based on previous research and feasibility. 9,13,14,[20][21][22][23][24][25][26][27]33 Candidate predictors were self-reported and spanned 3 domains: demographic (6 variables), health status (28 variables), and dizziness (33 variables). Dizziness-related impairment at baseline was assessed with both the full 25-item DHI 29 and the 10-item screening version of the DHI (DHI-S).…”
Section: Candidate Predictorsmentioning
confidence: 99%
“…This identification could prompt the physician to consider targeting factors potentially contributing to dizziness in these high-risk patients, even when the cause is unclear. 9,13,[20][21][22][23][24][25][26][27] Two ongoing trials are investigating the effectiveness of a multifactorial intervention for factors contributing to dizziness in older adults. 28,45 Future results of these studies may provide more specific guidance on multifactorial therapy that is effective in reducing dizziness symptoms.…”
Section: Comparison With Existing Literaturementioning
confidence: 99%
“…9,13 As a result, primary care physicians often manage dizziness in this age-group with a wait-andsee strategy, 2 although they could also focus on targeting potential contributing factors such as multiple drug use or depressive symptoms. 9,13,[20][21][22][23][24][25][26][27] Identification of patients with an unfavorable prognosis, even those with an unknown cause of dizziness, may contribute to better care, for example, by targeting potential contributing factors to dizziness in patients with an unfavorable dizziness prognosis. 9,13,[20][21][22][23][24][25][26][27] Only a single study has presented a prediction model to assess dizziness prognosis in older patients.…”
Section: Introductionmentioning
confidence: 99%
“…9,13,[20][21][22][23][24][25][26][27] Identification of patients with an unfavorable prognosis, even those with an unknown cause of dizziness, may contribute to better care, for example, by targeting potential contributing factors to dizziness in patients with an unfavorable dizziness prognosis. 9,13,[20][21][22][23][24][25][26][27] Only a single study has presented a prediction model to assess dizziness prognosis in older patients. 24 Yet, the researchers choose to exclude the strongest predictor, dizziness-related impairment as measured with the Dizziness Handicap Inventory (DHI), from their final prediction model because the score does not indicate causal mechanisms and therefore does not provide clues for treatment.…”
We developed an easy-to-use risk score for dizziness-related impairment in primary care. The risk score, consisting of only 4 predictors, will help primary care physicians identify patients at high risk for an unfavorable course of dizziness.
“…Potentially, the separate components of the intervention, and in particular the multifactorial design of the intervention, were too much of a burden for the older study population. Although many researchers suggest multifactorial treatment for older dizzy people [ 7 , 19 – 21 , 24 , 48 – 51 ], we should reconsider whether this is feasible in daily practice. Instead of multifactorial treatment, future research could focus on a sequential treatment, e.g.…”
ObjectivesDizziness is common in older people. Physicians are often unable to identify a specific cause for dizziness in older people, even after an extensive diagnostic work-up. A prognosis-oriented approach, i.e. treating modifiable risk factors for an unfavourable course of dizziness, may reduce dizziness-related impairment in older people in primary care.DesignCluster randomized controlled trial.Setting45 primary care practices in The Netherlands.Participants168 participants aged ≥65y who consulted their general practitioner for dizziness and experienced significant dizziness-related impairment (Dizziness Handicap Inventory (DHI) ≥30). Participants were part of to the intervention group (n = 83) or control group (n = 85), depending on whether they were enlisted in an intervention practice or in a control practice.InterventionsThe multifactorial intervention consisted of: medication adjustment in case of ≥3 prescribed fall-risk-increasing drugs (FRIDs) and/or stepped mental health care in case of anxiety disorder and/or depression and/or exercise therapy in case of impaired functional mobility. The intervention was compared to usual care.Outcome measuresThe primary outcome was dizziness-related impairment. Secondary outcomes were quality of life (QoL), dizziness frequency, fall frequency, anxiety and depression, use of FRIDs.ResultsIntention-to-treat analysis showed no significant intervention effect on dizziness-related impairment (DHI score difference -0.69 [95% CI -5.66;4.28]; p = 0.79). The intervention proved effective in reducing the number of FRIDs (FRID difference -0.48 [95% CI -0.89;-0.06]; p = 0.02). No significant intervention effects were found on other secondary outcomes. The uptake of and adherence to the interventions was significantly lower in patients eligible for ≥2 interventions compared to patients eligible for one intervention (p<0.001).ConclusionsThe multifactorial intervention for dizziness in older patients showed no significant intervention effect on most outcomes and adherence to the multifactorial intervention was low. Although multifactorial treatment for older dizzy people seems promising in theory, we question its feasibility in daily practice. Future research could focus on a sequential treatment for dizziness, e.g. measuring effectiveness of various evidence-based therapies in a stepwise approach.
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