Abstract
BackgroundThe current diagnosis-oriented approach of dizziness does not suit older patients. Often, it is difficult to identify a single underlying cause, and when a diagnosis is made, therapeutic options may be limited. Identification of predictors of dizziness may provide new leads for the management of dizziness in older patients. The aim of the present study was to investigate long-term predictors of regular dizziness in older persons.MethodsPopulation-based cohort study of 1,379 community-dwelling participants, aged ≥60 years, from the Longitudinal Aging Study Amsterdam (LASA). Regular dizziness was ascertained during face-to-face medical interviews during 7- and 10-year follow-up. We investigated 26 predictors at baseline from six domains: socio-demographic, medical history, medication, psychological, sensory, and balance/gait. We performed multivariate logistic regression analyses with presence of regular dizziness at 7- and 10-year follow-up as dependent variables. We assessed the performance of the models by calculating calibration and discrimination.ResultsPredictors of regular dizziness at 7-year follow-up were living alone, history of dizziness, history of osteo/rheumatoid arthritis, use of nitrates, presence of anxiety or depression, impaired vision, and impaired function of lower extremities. Predictors of regular dizziness at 10-year follow-up were history of dizziness and impaired function of lower extremities. Both models showed good calibration (Hosmer-Lemeshow P value of 0.36 and 0.31, respectively) and acceptable discrimination (adjusted AUC after bootstrapping of 0.77 and 0.71).ConclusionsDizziness in older age was predicted by multiple factors. A multifactorial approach, targeting potentially modifiable predictors (e.g., physical exercise for impaired function of lower extremities), may add to the current diagnosis-oriented approach.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2318-14-133) contains supplementary material, which is available to authorized users.
Highlights
The current diagnosis-oriented approach of dizziness does not suit older patients
We investigated predictors from six domains: socio-demographic, medical history, medication, psychological, sensory, and balance/gait, in a large nationally representative sample from the Longitudinal Aging Study Amsterdam (LASA)
Potential predictors of regular dizziness Based on previous research, we examined 26 potential predictors of regular dizziness [2,3,4,5,11,16,17]
Summary
The current diagnosis-oriented approach of dizziness does not suit older patients. Often, it is difficult to identify a single underlying cause, and when a diagnosis is made, therapeutic options may be limited. Dizziness can lead to severe limitations in daily functioning and is associated with depressive symptoms [3,4,5], poor self-rated health [2,6], and reduced quality of life [7] It is a major risk factor for falling [7,8], leading to fatal and Despite the aetiological differences between younger and older dizzy patients, guidelines on dizziness advocate the same diagnosis-oriented approach for all patients regardless of their age (http://cks.nice.org.uk/vertigo). This approach does not suit older patients presenting with dizziness. Identification of long-term predictors of dizziness in older people may provide new leads for the management of dizziness in older patients
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