Department of Otolaryngology, Massachusetts Eye and Ear Infirmary , Boston, Massachusetts, U.S.A; Department of Otology and Laryngology, Harvard Medical School , Boston, Massachusetts, U.S.A.
Laryngoscope. 2013 Oct;123(10):2539-43. doi: 10.1002/lary.24087. Epub 2013 May 29.
OBJECTIVES/HYPOTHESIS: Characterize health care practice patterns for balance disorders in the elderly.
Cross-sectional analysis of national health care survey.
Balance disorder cases in patients aged ≥65 years were extracted from the 2008 National Health Interview Survey. Records were analyzed for health professionals seen, diagnostic testing ordered, diagnoses given, and treatments offered. Relationships between diagnostic success, imaging studies, and specialty providers seen were compared.
Among 7.02 ± 0.22 million elderly persons reporting a balance problem, 50.0% (3.44 ± 0.16 million) saw a health professional, and 35.8% saw ≥3 providers; 59.6% of elderly patients reported a diagnosed cause for the balance problem. The most common causes were medication side effects (11.3%), inner ear infection (11.0%), heart disease (8.6%), and loose ear crystals (7.9%). Imaging studies had been obtained in 56.7% (2.00 ± 0.11 million cases). Among 24.3% of patients receiving some form of treatment, 61.7% had been taking prescription medication, most commonly diuretic agents (36.5%), anxiolytic agents (25.1%), and meclizine (21.4%). Seeing an otolaryngologist or neurologist was associated with a higher but similar rate of diagnostic imaging studies (70.1%, P = .029 and 78.5%, P < .001). However, obtaining an imaging study was not associated with a diagnosed cause of the balance disorder (61.5% with imaging vs. 56.9% without, P = .265).
Despite a high prevalence of balance problems in the elderly, a significant proportion do not come to a clear diagnosis. There is a noteworthy rate of prescription medication utilization in this population. Given an increasingly aging population, attention needs to be given to balance problems in the elderly to optimize diagnosis and health care utilization.
2b.
目的/假设：描述老年人平衡障碍的医疗保健实践模式。
全国健康调查的横断面分析。
从 2008 年全国健康访谈调查中提取年龄≥65 岁的平衡障碍患者病例。分析记录就诊的卫生专业人员、所开诊断性检查、诊断结果和提供的治疗。比较诊断成功率、影像学研究与专科医生就诊之间的关系。
在报告有平衡问题的 702 万±22 万老年人中，50.0%（344 万±160 万）就诊于卫生专业人员，35.8%就诊于≥3 个提供者；59.6%的老年患者报告有明确的平衡问题病因。最常见的病因是药物副作用（11.3%）、内耳感染（11.0%）、心脏病（8.6%）和耳内松动晶体（7.9%）。影像学检查已在 56.7%（200 万±11 万例）中获得。在接受某种形式治疗的 24.3%患者中，61.7%服用处方药，最常见的是利尿剂（36.5%）、抗焦虑药（25.1%）和美克洛嗪（21.4%）。看耳鼻喉科医生或神经科医生与更高但相似的诊断性影像学研究率相关（70.1%，P=0.029 和 78.5%，P<0.001）。然而，获得影像学检查与平衡障碍的明确病因无关（有影像学检查者为 61.5%，无影像学检查者为 56.9%，P=0.265）。
尽管老年人中平衡问题的患病率很高，但相当一部分人没有明确的诊断。该人群中开具处方药物的比例很高。鉴于人口老龄化日益严重，需要关注老年人的平衡问题，以优化诊断和医疗保健的利用。
2b。
