Volume 60, Issue 12 p. 2263-2269
Clinical Investigations

Functional Prognosis of Dizziness in Older Adults in Primary Care: A Prospective Cohort Study

Jacquelien Dros MD

Corresponding Author

Jacquelien Dros MD

Department of Family Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

Address correspondence to Jacquelien Dros, Department of Family Medicine, Academic Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, the Netherlands. E-mail: [email protected]Search for more papers by this author
Otto R. Maarsingh MD

Otto R. Maarsingh MD

Department of Family Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands

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Leo Beem PhD

Leo Beem PhD

Department of Family Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

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Henriëtte E. van der Horst PhD

Henriëtte E. van der Horst PhD

Department of Family Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands

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Gerben ter Riet PhD

Gerben ter Riet PhD

Department of Family Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

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François G. Schellevis PhD

François G. Schellevis PhD

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Henk C. P. M. van Weert MD

Henk C. P. M. van Weert MD

Department of Family Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands

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First published: 11 December 2012
Citations: 30

Abstract

Objectives

To investigate the 6-month functional prognosis of dizziness in older adults in primary care, to identify important predictors of dizziness-related impairment, and to construct a score to assist risk prediction.

Design

Prospective cohort study with 6-month follow-up.

Setting

Twenty-four primary care practices in the Netherlands.

Participants

Four hundred seventeen older adults (mean age 78.5, range 65–95, 74% female) presenting consecutively to primary care with dizziness.

Measurements

Tests, including history and physical and additional examination, previously selected by an international expert panel and based on an earlier systematic review, were performed. The main outcome measure was 6-month dizziness-related impairment score measured using the Dizziness Handicap Inventory.

Results

Follow-up was complete for 92% of participants. Although 61% of participants experienced less impairment at 6 months, 130 participants (34%) showed persistent dizziness-related impairment. Factors most predictive of dizziness-related impairment at 6 months were onset of dizziness at least 6 months before inclusion, standing still as a dizziness-provoking circumstance, trouble with walking or (almost) falling (associated symptom), polypharmacy, absence of diabetes mellitus, presence of anxiety or depressive disorder, and impaired functional mobility. A score was constructed using these predictors to estimate the functional prognosis of dizziness at 6 months.

Conclusion

A score based on the presence of easily obtainable clinical information facilitates identification of older adults in primary care with poor functional prognosis of their dizziness without exactly knowing the cause(s) of their dizziness. Clinical management might be most effective by treating factors that can be influenced, such as polypharmacy, anxiety and depression, and functional mobility.