Kruschinski C, Klaassen A, Breull A, Broll A, Hummers-Pradier E
Institute of General Practice, OE 5440, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover.
Z Gerontol Geriatr. 2010 Oct;43(5):317-23. doi: 10.1007/s00391-010-0098-5. Epub 2010 Mar 4.
Dizziness as a geriatric syndrome needs to be assessed using a multi-dimensional, patient-centred approach in addition to a disease-orientated strategy. The aim of the study was to determine the priorities of elderly patients by a specific needs questionnaire, the"Dizziness Needs Assessment" (DiNA), and to evaluate its psychometric properties.
General practitioners (GPs) distributed questionnaires containing the DiNA as well as the Patients' Intentions Questionnaire (PIQ) to patients aged at least 65 years and suffering from dizziness. Items of both questionnaires were analysed by frequencies, means and rank correlations. Factor structure was explored by principal component analysis.
A total of n=123 patients (mean age 76 years, 73% women) had suffered from dizziness on average for more than 3 years (57% chronic, i.e. >6 months). Knowing the cause of the dizziness was rated as very important by patients, and about half of them wished that their doctor would make more effort to investigate this. Among other differences, chronically dizzy patients ranked the risk of falling significantly higher than those with acute dizziness. Factor analysis revealed four subscales: "handicap and mobility" showed a very good reliability of 0.77 (Cronbach's α), indicating a "trait", whereas the other subscales rather indicated "state" characteristics. Validation coefficients showed that PIQ assesses general patient needs compared to the more specific dizziness-related needs revealed by the DiNA.
The DiNA proved to be a valuable instrument to assess the specific priorities of elderly patients suffering from dizziness. Regarding the limited therapy options for dizziness in old age, a doctor-guided shift of patients' attention from causes to symptom-related implications could be a promising approach.
头晕作为一种老年综合征，除了采用以疾病为导向的策略外，还需要使用多维度、以患者为中心的方法进行评估。本研究的目的是通过一份特定的需求问卷“头晕需求评估”（DiNA）来确定老年患者的优先事项，并评估其心理测量特性。
全科医生（GPs）向至少65岁且患有头晕的患者分发包含DiNA以及患者意向问卷（PIQ）的问卷。通过频率、均值和等级相关性分析两份问卷的项目。通过主成分分析探索因子结构。
共有n = 123名患者（平均年龄76岁，73%为女性）平均头晕超过3年（57%为慢性，即>6个月）。患者认为了解头晕原因非常重要，约一半患者希望医生能更加努力地对此进行调查。在其他差异方面，慢性头晕患者将跌倒风险的排名显著高于急性头晕患者。因子分析揭示了四个子量表：“残疾与行动能力”显示出非常好的信度，为0.77（克朗巴哈α系数），表明是一种“特质”，而其他子量表更表明是“状态”特征。验证系数表明，与DiNA揭示的更具体的头晕相关需求相比，PIQ评估的是一般患者需求。
DiNA被证明是评估老年头晕患者特定优先事项的有价值工具。鉴于老年头晕的治疗选择有限，医生引导患者将注意力从病因转移到与症状相关的影响上可能是一种有前景的方法。
