Impact of dizziness on everyday life in older primary care patients: a cross-sectional study

Abstract

Background: Dizziness is a common and often disabling symptom, but diagnosis often remains unclear; especially in older persons where dizziness tends to be multicausal. Research on dizziness-related impairment might provide options for a functional oriented approach, with less focus on finding diagnoses. We therefore studied dizziness-related impairment in older primary care patients and aimed to identify indicators related to this impairment.

Methods: In a cross-sectional study we included 417 consecutive patients of 65 years and older presenting with dizziness to 45 general practitioners in the Netherlands from July 2006 to January 2008. We performed tests, including patient history, and physical and additional examination, previously selected by an international expert panel and based on an earlier systematic review. Our primary outcome was impact of dizziness on everyday life measured with the Dutch validated version of the Dizziness Handicap Inventory (DHI). After a bootstrap procedure (1500x) we investigated predictability of DHI-scores with stepwise backward multiple linear and logistic regressions.

Results: DHI-scores varied from 0 to 88 (maximum score: 100) and 60% of patients experienced moderate or severe impact on everyday life due to dizziness. Indicators for dizziness-related impairment were: onset of dizziness 6 months ago or more (OR 2.8, 95% CI 1.7-4.7), frequency of dizziness at least daily (OR 3.3, 95% CI 2.0-5.4), duration of dizziness episode one minute or less (OR 2.4, 95% CI 1.5-3.9), presence of anxiety and/or depressive disorder (OR 4.4, 95% CI 2.2-8.8), use of sedative drugs (OR 2.3, 95% CI 1.3-3.8) , and impaired functional mobility (OR 2.6, 95% CI 1.7-4.2). For this model with only 6 indicators the AUC was .80 (95% CI .76-.84).

Conclusions: Dizziness-related impairment in older primary care patients is considerable (60%). With six simple indicators it is possible to identify which patients suffer the most from their dizziness without exactly knowing the cause(s) of their dizziness. Influencing these indicators, if possible, may lead to functional improvement and this might be effective in patients with moderate or severe impact of dizziness on their daily lives.

Figure 1

Observed and predicted probabilities of experiencing moderate or severe impact of dizziness (DHI > 30) for all values of the simple sum score (0-6) of indicators. o: proportion of observed dizziness impact (DHI > 30) corresponding with that particular sum score; — : proportion of predicted dizziness impact (DHI > 30); the grey band represents the 95% confidence interval. A simple sum score of ≥4 means a probability of ≥.80 that an older patient experiences moderate or severe impact of dizziness on everyday life.

Figure 2

ROC curve of the final logistic model with six indicators related to the impact of dizziness on everyday life of older primary care patients. Area Under the Curve (AUC) is .80 (CI .76-.84). In the ROC curve the predicted probabilities for all values of the sum score and their corresponding sensitivity and (1-)specificity. The predicted probability of 0.82 corresponds with a simple sum score of 4.