Prognosis and Survival of Older Patients With Dizziness in Primary Care: A 10-Year Prospective Cohort Study

Abstract

PURPOSE The prognosis of older patients with dizziness in primary care is unknown. Our objective was to determine the prognosis and survival of patients with different subtypes and causes of dizziness. METHODS In a primary care prospective cohort study, 417 older adults with dizziness (mean age 79 years) received a full diagnostic workup in 2006-2008. A panel of physicians classified the subtype and primary cause of dizziness. Main outcome measures were mortality and dizziness-related impairment assessed at 10-year follow-up. RESULTS At 10-year follow-up 169 patients (40.5%) had died. Presyncope was the most common dizziness subtype (69.1%), followed by vertigo (41.0%), disequilibrium (39.8%), and other dizziness (1.7%). The most common primary causes of dizziness were cardiovascular disease (56.8%) and peripheral vestibular disease (14.4%). Multivariable adjusted Cox models showed a lower mortality rate for patients with the subtype vertigo compared with other subtypes (hazard ratio [HR] = 0.62; 95% CI, 0.40-0.96), and for peripheral vestibular disease vs cardiovascular disease as primary cause of dizziness (HR = 0.46; 95% CI, 0.25-0.84). After 10 years, 47.7% of patients who filled out the follow-up measurement experienced substantial dizziness-related impairment. No significant difference in substantial impairment was seen between different subtypes and primary causes of dizziness. CONCLUSIONS The 10-year mortality rate was lower for the dizziness subtype vertigo compared with other subtypes. Patients with dizziness primarily caused by peripheral vestibular disease had a lower mortality rate than patients with cardiovascular disease. Substantial dizziness-related impairment in older patients with dizziness 10 years later is high, and indicates that current treatment strategies by family physicians may be suboptimal.

Dizziness and health-related quality of life among older adults in an urban population: a cross-sectional study

“…Dizziness tends to be more common with increasing age as well as with higher morbidity and may well be a sign associated with morbidity, also in younger ages [ 5 ]. Having dizziness, non-vertigo type, has been associated with higher mortality risk, compared to dizziness due to peripheral causes [ 38 ]. The most common duration of dizziness was seconds and symptoms triggered by raising up or by positional changes, symptoms often seen in orthostatic hypotension or benign paroxysmal positional vertigo (BPPV).…”

Long‐Term Survival in 1,931 Patients With Dizziness: Disease‐ and Symptom‐Specific Mortality

“…15 Although spinning vertigo was associated with reduced risk of mortality after adjusting for age, sex, and comorbidities, it failed to reach significance in the final model (stepwise inclusion) when other symptom characteristics, including timing, were included. Van Vugt and colleagues found vertigo to be associated with a more favorable outcome than other types of dizziness among elderly patients in primary care, 5 whereas Newman-Toker and colleagues found that the type of dizziness was inconsistently reported by patients in an emergency department. 6 Our findings indicated that the time course of symptoms such as short attacks or episodic dizziness was more relevant to survival than the quality of symptoms, such as spinning vertigo.…”

Referral trajectories in patients with vertigo, dizziness and balance disorders and their impact on health-related quality of life and functioning: results from the longitudinal multicenter study MobilE-TRA

“…Distinct treatable vestibular disease entities, dizziness caused by medication, cardiovascular disease or diabetes may align with symptoms of the ageing of vestibular, proprioceptive or somatosensory systems. Therefore, a considerable percentage of older adults with confirmed vestibular vertigo experience limited functioning and impairment in their health-related quality of life (HRQoL) due to their untreated VDB [ 7 , 8 ].…”