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.
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.
Authors: Vincent A van Vugt; Gülsün Bas; Johannes C van der Wouden; Jacquelien Dros; Henk C P M van Weert; Lucy Yardley; Jos W R Twisk; Henriëtte E van der Horst; Otto R Maarsingh Journal: Ann Fam Med Date: 2020-03 Impact factor: 5.166
Authors: Hanneke Stam; Otto R Maarsingh; Martijn W Heymans; Henk C P M van Weert; Johannes C van der Wouden; Henriëtte E van der Horst Journal: Ann Fam Med Date: 2018-09 Impact factor: 5.166
Authors: Otto R Maarsingh; Hanneke Stam; Peter M van de Ven; Natasja M van Schoor; Matthew J Ridd; Johannes C van der Wouden Journal: BMC Geriatr Date: 2014-12-15 Impact factor: 3.921
Authors: Vincent A van Vugt; Johannes C van der Wouden; Judith E Bosmans; Martin Smalbrugge; Willianne van Diest; Rosie Essery; Lucy Yardley; Henriëtte E van der Horst; Otto R Maarsingh Journal: BMJ Open Date: 2017-01-20 Impact factor: 2.692
Authors: Hanneke Stam; Marjanne Wisse; Bram Mulder; Johannes C van der Wouden; Otto R Maarsingh; Henriëtte E van der Horst Journal: BMC Fam Pract Date: 2016-07-16 Impact factor: 2.497