Prevalence of and factors related to mild and substantial dizziness in community-dwelling older adults: a cross-sectional study

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 interviewed and examined. Subjects with dizziness answered the University of California Los Angeles Dizziness Questionnaire and questions about provoking movements. The groups with substantial, mild, or no dizziness were compared with regard to age, sex, diseases, drugs, blood pressure, physical activity, exercises, falls, fear of falling, quality of life, general health, mobility aids, and physical performance. Results: In this sample, 79 subjects experienced substantial and 46 mild dizziness. Subjects with substantial dizziness were less physically active, reported more fear of falling, falls, depression/anxiety, diabetes, stroke/TIA, heart disease, a higher total number of drugs and antihypertensive drugs, lower quality of life and general health, and performed worse physically. Conclusions: There are many and complex associations between dizziness and factors like falls, diseases, drugs, physical performance, and activity. For most of these factors, the associations are stronger in subjects with substantial dizziness compared with subjects with mild or no dizziness; therefore, it is relevant to differ between mild and substantial dizziness symptoms in research and clinical practice in the future.

Predicting an Unfavorable Course of Dizziness in Older Patients

“…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).…”

“…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.…”

“…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.…”

“…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.…”

Effectiveness of a multifactorial intervention for dizziness in older people in primary care: A cluster randomised controlled trial

“…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.…”