Institute of General Practice, Hannover Medical School, Hannover, Germany.
BMC Fam Pract. 2011 Jun 24;12:58. doi: 10.1186/1471-2296-12-58.
Dizziness is a common complaint of older patients in primary care, yet not much is known about the course of incident dizziness. The aim of the study was to follow-up symptoms, subjective impairments and needs of older patients (≥65) with incident dizziness and to determine predictors of chronic dizziness. Furthermore, we analysed general practitioners' (GPs') initial diagnoses, referrals and revised diagnoses after six months.
An observational study was performed in 21 primary care practices in Germany, including a four-week and six-month follow-up. A questionnaire comprising characteristic matters of dizziness and a series of validated instruments was completed by 66 participants during enrollment and follow-up (after 1 month and 6 months). After six months, chart reviews and face-to-face interviews were also performed with the GPs.
Mean scores of dizziness handicap, depression and quality of life were not or only slightly affected, and did not deteriorate during follow-up; however, 24 patients (34.8%) showed a moderate or severe dizziness handicap, and 43 (62.3%) showed a certain disability in terms of quality of life at the time of enrollment. In multivariate analysis, n = 44 patients suffering from chronic dizziness (dependent variable, i.e. relapsing or persistent at six months) initially had a greater dizziness handicap (OR 1.42, 95%CI 1.05-1.47) than patients with transient dizziness. GPs referred 47.8% of the patients to specialists who detected two additional cases of benign paroxysmal positional vertigo (BPPV).
New-onset dizziness relapsed or persisted in a considerable number of patients within six months. This was difficult to predict due to the patients' heterogeneous complaints and characteristics. Symptom persistence does not seem to be associated with deterioration of the psychological status in older primary care patients. Management strategies should routinely consider BPPV as differential diagnosis.
头晕是初级保健中老年患者常见的主诉，但对于偶发性头晕的病程知之甚少。本研究旨在随访偶发性头晕的老年患者（≥65 岁）的症状、主观障碍和需求，并确定慢性头晕的预测因素。此外，我们还分析了全科医生（GP）在 6 个月后的初始诊断、转诊和修正诊断。
在德国的 21 个初级保健机构中进行了一项观察性研究，包括四周和六个月的随访。66 名参与者在入组和随访期间（1 个月和 6 个月后）完成了一份包含头晕特征问题和一系列经过验证的工具的问卷。6 个月后，还对全科医生进行了病历回顾和面对面访谈。
头晕障碍、抑郁和生活质量的平均评分没有或只有轻微影响，并且在随访过程中没有恶化；然而，24 名患者（34.8%）在入组时存在中度或重度头晕障碍，43 名患者（62.3%）在生活质量方面存在一定的残疾。在多变量分析中，n=44 名患有慢性头晕（因变量，即 6 个月时复发或持续存在）的患者最初的头晕障碍更大（OR 1.42，95%CI 1.05-1.47）比一过性头晕患者。全科医生将 47.8%的患者转诊给专家，专家发现了另外两例良性阵发性位置性眩晕（BPPV）。
在六个月内，相当数量的新发头晕复发或持续存在。由于患者的主诉和特征存在异质性，这很难预测。症状持续似乎与老年初级保健患者心理状态的恶化无关。管理策略应常规考虑 BPPV 作为鉴别诊断。
