Dizziness a Serious, Persistent Issue for Older Adults

A new study from investigators at Amsterdam University Medical Centers in Europe is shedding light on how dizziness in older adults in a primary care setting can inform physicians on potential prognosis.

Results of the investigators' research indicated different subtypes of dizziness had a greater risk of mortality while other subtypes were associated with varying degrees of dizziness-related impairment.

Despite being an issue for many older adults, dizziness and how its presence can inform decision-making and help identify high-risk patients. With this in mind, investigators designed a prospective cohort study of primary care patients with dizziness to assess the prognosis and survival with different subtypes and causes of dizziness.

Investigators identified a cohort of 417 primary care patients 65 years of age or older with dizziness that persisted for at least 2 weeks between June 2006 through 2008. Data recorded included sociodemographic characteristics, risk factor information, medical history, and characteristics of dizziness. Investigators also conducted measurements of cardiovascular, locomotor, neurologic, and visual function.

Individuals in the study were classified by dizziness subtype by a panel of physicians and this same panel assessed relative contribution of causes of dizziness for each patient from 9 groups of medical conditions, including cardiovascular disease, peripheral vestibular disease, psychiatric disease, locomotor disease, neurologic disease, adverse drug effect, metabolic or endocrine conditions, impaired vision, and other causes.

The primary outcomes of the study were mortality and substantial impairment due to dizziness. Follow-up measurements occurred between October 2016 and January 2018. Investigators identified deaths through physician records and reports by next of kin.

Investigators noted that 2 analyses were performed as part of the current. The first being an exploratory analysis and the seance a posthoc sensitivity analysis to confirm the findings of the first analysis—both were performed using Cox proportional hazard models.

Over the 10-year follow-up period, 169 of the 417 patients included had died. The mean age of the entire study cohort was 79 years, 73.6% were women, and 69.3% had experienced dizziness for 6 months or longer. Presyncope (69.1%) was the most common dizziness subtype followed by vertigo (41.0%), disequilibrium (39.8%), and other dizziness (1.7%).

Analyses revealed 52% of patient shad 1 subtype, 32.9% had 2 subtypes, and 11.2% had 3 subtypes. The most common causes of dizziness were cardiovascular disease (56.8%) and peripheral vestibular disease (14.4%), according to investigators.

Results of the analyses indicated vertigo was associated with a lower 10-year mortality risk compared to patricians with other subtypes (HR 0.62; 95% CI, 0.40-0.96). Additionally, dizziness from peripheral vestibular disease was also associated with a lower risk of mortality (HR 0.46; 95% CI, 0.25-0.84) when compared to dizziness from cardiovascular disease.

Investigators noted that at the end of the 10-year follow-up period, 47.7% of patients had experienced substantial dizziness-related impairment. Results also pointed out 26% of these patients reported experiencing substantial dizziness-related impairment at every measurement.

“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,” investigators wrote.

This study, “Prognosis and Survival of Older Patients With Dizziness in Primary Care: A 10-Year Prospective Cohort Study,” was published in the Annals of Family Medicine.