Abstract
Objectives
The aim of this study was to determine the prevalence and related predictors of dizziness in a sample of community-dwelling people 65 years of age and older living in a metropolitan area in Germany.
Design
Prospective cohort study.
Setting
Interdisciplinary Centre of Gerontology at the University of Erlangen-Nuremberg, Germany.
Participants
6000 people aged 65 years and older recruited and randomized from the registration office, 1801 were fully evaluated at baseline and were re-evaluated in a prospective follow-up two years later. A full data set was obtained for 620 participants, of which 297 (47.9%) were females. Mean age was 73.45 ± 6.05. 200 participants (32.4%) were 65–69 years, 315 (51%) were 70–79 years, 92 (14.9%) 80–89 years and 11 (1.8%) 90 years and older.
Measurements
Demographic, medical, functional and psychological factors were measured by a standardised questionnaire in 2004. In a follow-up survey participants were reevaluated in a prospective design two years later (2006), including a dizziness questionnaire, containing frequency, duration, space of dizziness and releasing positions and activities.
Results
At the second measurement 181 persons (29.2%) reported dizziness in the last 6 months. Dizziness was age dependent, with a prevalence of 27% in participants aged 70 years and younger, up to 54% in the group of 90 years and older. 96 (68.2%) persons reported daily or weekly dizziness. 46 (27.9%) participants reported multiple sensations of dizziness. In 108 (59.7) persons dizziness was released by multiple positions or activities. The main predictors of dizziness were age, female gender, cardiovascular disease, osteoporosis, depression, sleep disorder, disturbance of memory, shortsightedness (defined by glasses), incontinence, 3 and more medical conditions, 4 and more medications, poor health status, falls and mobility problems. We found similar risk factors for dizziness and falls.
Conclusion
Dizziness is a very common symptom in older community dwelling persons. Comorbidity, poor health status and mobility problems are strong medical predictors; age and female gender and decline in mobility are important predictors as well. Our study suggests, that dizziness in older age is often caused by multifactorial medical and functional conditions. Gait disorders and mobility problems also seem to play an important role in dizziness among older people. Therefore, interventions in dizziness should be developed in a multifactorial way. We suggest, that the interventions to be tested first, should be those that have been previously successful in older persons with gait disorders and falls.
Key words: Dizziness, old age, gait disorders, risk factor
Introduction
Dizziness although being a frequent and important symptom among older people is not well-defined. It represents a vague term describing a variety of sensations, such as feeling lightheaded, floating, whoozy, giddy, confused, helpless or fuzzy. Different studies report prevalences of dizziness between 13% and 38% (1, 2, 3, 4, 5). The different prevalence rates reported might be due to selection of the samples included. Dizziness has been associated with an increased risk for falls, strokes, syncope, functional disability, nursing home placement and death (6, 7, 8, 9, 10). Diagnostic findings from several studies have varied greatly and are probably due in part to the different populations studied and the disparate diagnoses criteria used. So vestibular disease was identified as a main cause in 4% to 64% of cases of dizziness (11, 12, 13, 14). Cardiovascular causes were identified in 0% to 70% of dizziness, multiple diagnoses have been assigned in 0% to 85% and no diagnosis could be found in 8% to 22% of cases (4, 11, 12, 13, 14, 15, 16).
On this background the aim of this study was to determine the prevalence, related predictors and other factors of dizziness in a random sample of community-dwelling people of 65 years and older people living in a metropolitan area in Germany.
Methods
Participants
In the context of this study about falls among older people 6000 community-dwelling persons aged 65 years and older living in the metropolitan area of Erlangen, Nuremberg, and Fuerth with together about 712000 inhabitants were recruited and randomized from the registration office of each city in the year 2004. This sample was contacted with a mailed questionnaire. 1985 persons (33.1%) returned the questionnaire with voluntary information on name and address or anonymously. Cases with missing data on falls and living conditions were excluded, leaving 1801 participants (30%) for data analysis. In 2006 these 1801 participants, who took part in the baseline were contacted again and requested to answer the follow-up questionnaire. 622 persons returned the questionnaire, 620 providing information about dizziness. The analysis presented in this paper is based on these participants. Mean age was 73.45 years, 323 (52.1%) were male, 297 (47.9%) female. 200 participants (32.4%) were up to 69 years, 315 (51%) 70-79, 92 (14.9%) 80-89 and 11 (1.8%) 90 years and older.
Baseline and follow-up assessment
At baseline data on age, gender, marital status, income, education and last occupation were obtained for demographic reason. Data regarding height, weight, subjective health, medications, diseases including the presence of dizziness, the number of falls within the last six months and the status of mobility were also assessed. Because dizziness is an umbrella term, we asked for different sensations of dizziness in the follow-up. To detect as many cases as possible, we started with the unspecific question “Did you experience dizziness within the last 6 months?”. In addition, participants were asked about space of time, frequency, duration of dizziness and sensations and positions. Activity level and mobility status were assessed as well as data on anxiety (scale from 1 to 6; with a score of 1 representing no anxiety and a score of 6 representing high levels of anxiety). Furthermore, the GDS4 short version for depression (17) was used and name and numbers of medications were assessed. Participants reported about any falls and consequences within the last six months.
Data Analysis
The analysis of this study was based on 620 participants who returned the questionnaire in the baseline and follow-up and gave information about dizziness. Descriptive analysis was performed for demographic, disease and predictor variables. The prevalence of dizziness was calculated. Univariate analyses for predictors of falls and recurrent falls with Chi-square statistics for categorical and Student’s t-test for continuous data were performed, P <0.05 (2-tailed) was considered statistically significant. Bivariate odds ratios with their 95% confidence intervals were calculated for the independent variables. The statistical package SPSS version 14 for Windows was used for data analyses.
Results
Prevalence of dizziness
Out of 620 participants n=181 (29.2%) reported episodes of dizziness during the last 6 months. We found a significant correlation between the occurrence of dizziness and age. While people 79 years of age and younger reported a prevalence of about 27%, participants between 80 and 89 years of age a prevalence of 38% and participants 90 years of age and older even reported a prevalence of 54%. People living alone had a higher risk for dizziness (OR 1.85 [1.28-2.67]). However this effect could be due to a connection with age. The occurrence of dizziness was related to the number of reported medical diagnoses and to the subjective rating of health. Persons with a low self-rating of health reported higher levels of dizziness. Females suffered more from dizziness than men (OR 1.73 [1.22-2.46]). Comparing male and female patients with dizziness we could not find any significant differences regarding age, number of medical conditions and medications. Females suffering from dizziness were more anxious than men, did fall more often and reported more cases of dizziness while turning the head or standing.
Frequency, period and duration of dizziness
Frequency of dizziness: 96 (68.6%) participants reported daily or weekly episodes of dizziness, while 44 (31.4%) participants suffered from dizziness only once in a month. Participants with daily dizziness were characterized by one or more of the following: suffering from diabetes, having a hip-endoprosthesis, having difficulties while walking 500m or getting up from bed, having difficulties in meeting friends, with inactive lifestyle, daily intake of 4 or more prescription drugs, comorbidity (3 or more diagnoses), cardiac syncopal episodes during the last two years and cardiovascular disease. Participants with dizziness while turning the head were also more likely to report daily dizziness
Period of dizziness: Participants were asked over which period the dizziness occurred. 67 (43.8%) participants reported of dizziness which occurred during a period of less than 2 months. 86 (56.2%) participants dizziness lasted over a period of more than 2 months. Participants with a longer period of dizziness suffered significantly more of osteoporosis, had a higher daily drug intake (4 or more drugs a day), had higher depression scores, were more likely to use walking aids and reported more often dizziness while turning the body. Marginal effects could be found for incontinence, a low subjective health, old age (80 years and older) and a high level of comorbidity (3 ore more diagnoses).
Duration of Dizziness: For 85 (48.9%) participants dizziness lasted only for seconds, 89 (51.1%) participants reported states of dizziness which lasted for minutes or even for hours. These participants were characterized by old age and a lower education level and a marginal lower rating of subjective health (see also Table 1).
Table 1.
Period, frequency and duration of dizziness (Number of participants, % of n).
| Period | Duration | ||
|---|---|---|---|
| seconds | minutes/hours | ||
| < 2 months | 38 (25.2) | 29 (19.2) | |
| ≥ 2 months | 35 (23.2) | 49 (32.5) | |
| N = 151; p = .06 |
|||
| Frequency | Duration | ||
|
seconds |
minutes/hours |
||
| Daily/weekly | 35 (25.7) | 57 (41.9) | |
| monthly | 33 (24.3) | 11 (8.1) | |
| N=136;p< .001 |
Sensations and positions
The frequency of different sensations according to Drachman (18, 19) and the positions and activities, who are associated with dizziness was shown in Table 2. 27.9% of the participants reported more than one sensation. Most frequently was losing balance (64.5%), followed by vertigo (27.9%). Feeling near faint occurred in 11.4%, sensations other than these had 13.9%.
Table 2.
Sensations and positions or activities reported by 181 older persons with dizziness. Single/multiple sensation(s)
| Characteristic | Participants, N (%) |
|---|---|
| Sensations reported as dizziness | |
| Single sensation | 119 (72.1) |
| Multiple sensations | 46 (27.9) |
| Specific sensation reported | |
| Loss of balance | 107 (64.5) |
| Spin | 68 (41) |
| Near faint | 19(11.4) |
| Other | 23 (13.9) |
| Position reported | |
| Single position | 63 (34.8) |
| Multiple positions | 108 (59.7) |
| None of these | 10 (5.5) |
| Positions or activities reported | |
| Getting up from lying down | 79 (45.9) |
| Getting up from sitting | 36 (20.9) |
| While standing | 50 (29.1) |
| While walking | 69 (40.1) |
| While turning body | 26 (15.1) |
| While turning head | 44 (25.8) |
| Head in a specific position | 20 (11.6) |
| Changing position lying in bed | 25 (14.5) |
| After eating |
3 (1.7) |
Getting up from lying down was the most common position associated with dizziness (45.9%), followed by walking (40.1%), standing (29.1%), turning head (25.8%) and getting up from sitting (20.9%). Only 34.8% reported one position or activity associated with dizziness, 59.7% more than one. 16 (9%) participants suffered from at least one syncope within the last two years. In 9 (56.2%) of those duration of dizziness was minutes and hours, in 13 (81.2%) the symptom occurred daily or weekly.
Predictors of dizziness
The characteristics of participants with and those without dizziness and the predictors of dizziness within six months before the follow-up are shown in Table 3.
Table 3.
Characteristics of participants (N=620), Predictors of dizziness
| At Baseline | ||||
|---|---|---|---|---|
| Characteristic | Dizziness | P | OR (95% CI) | |
| Yes | No | |||
| n= 181 (%) | n= 439 (%) | |||
| Sociodemographic | ||||
| Age > 80 years | 41 (22.9) | 62 (14.1) | .008 | 1.80 [1.16-2.80] |
| Female | 105 (58.0) | 192 (43.7) | .002 | 1.73 [1.22-2.46] |
| Living alone | 75 (41.9) | 119 (28.0) | .001 | 1.85 [1.28-2.67] |
| Education < 10 y | 90 (50.0) | 204 (46.8) | ns | 1.13 [.80-1.61] |
| Health related | ||||
| Shortside glasses | 72 (76.6) | 139 (63.2) | .02 | 1.90 [1.10-3.30] |
| Reading glasses | 106 (91.4) | 256 (92.1) | ns | .91 [.41-1.98] |
| Varifocals | 80 (70.2) | 197 (63.8) | ns | 1.33 [.84-2.12] |
| Poor and very poor | 68 (38.2) | 56 (12.8) | <.001 | 4.19 [2.77-6.33] |
| health status (self rated) | ||||
| Cardiovascular disease | 73 (48.3) | 161 (68.8) | .05 | 1.43 [.98-2.09] |
| Diabetes mellitus | 25 (16.6) | 56 (13.9) | ns | 1.22 [.73-2.04] |
| Osteoporosis | 33 (23.4) | 62 (15.7) | .04 | 1.63 [1.01-2.63] |
| Parkinson’s disease | 6 (4.3) | 0 (0) | <.001 | - |
| Depression (self report.) | 24 (17.4) | 20 (5.1) | <.001 | 3.89 [2.07-7.30] |
| Sleep disorder | 74 (50.3) | 80 (20.1) | <.001 | 4.02 [2.68-6.04] |
| Hip joint endoprosthesis | 27 (17.8) | 23 (5.8) | <.001 | 3.49 [1.93-6.31] |
| Incontinence | 51 (33.1) | 53 (13.5) | <.001 | 3.18 [2.04-4.96] |
| Disturbance of memory | 49 (31.6) | 44 (11.7) | <.001 | 3.48 [2.19-5.53] |
| BMI < 20 or > 30 | 44 (24.1) | 69 (15.8) | .012 | 1.72 [1.12-2.63] |
| 3 and more medical conditions | 76 (42.0) | 54 (12,3) | <.001 | 5.16 [3.42-7.77] |
| 4 and more medications taken | 72 (40.0) | 95 (22.0) | <.001 | 2.36 [1.62-3.44] |
| Falls and gait | ||||
| Falls | 55 (30.4) | 52 (11.8) | <.001 | 3.24 [2.11-4.99] |
| Fear of falling | 94 (53.1) | 105 (24.1) | <.001 | 3.55 [2.46-5.14] |
| Walker | 45 (25.6) | 47 (10.9) | <.001 | 2.80 [1.78-4.42] |
| Problems in getting up from bed | 9 (5.0) | 3 (.7) | <.001 | 7.58 [2.03-28.36] |
| Problems in homely mobility | 5 (2.8) | 7 (1.6) | ns | 1.74 [.54-5.57] |
| Problems in getting out | 16 (8.9) | 11 (2.6) | .001 | 3.71 [1.68-8.17] |
| At Follow-Up Assessment | ||||
| Problems in walking 500m | 70 (39.8) | 66 (15.1) | <.001 | 3.72 [2.49-5.55] |
| Low physical activity | 72 (41.9) | 94 (21.8) | <.001 | 2.58 [1.77-3.78] |
| Falls in the last 6 months | 55 (30.4) | 52 (11.8) | <.001 | 3.24 [2.11-4.99] |
| 4 and more medicaments | 81 (48.2) | 136 (36.2) | .001 | 1.60 [1.11-2.32] |
| Short-GDS ≥2 of 4 | 27 (20.9) | 30 (7.5) | <.001 | 3.24 [1.84-5.70] |
| Thyreoid agents* | 36 (21.4) | 52 (14.0) | .031 | 1.67 [1.05-2.68] |
| Antidementives * | 11 (6.5) | 11 (3.0) | .05 | 2.29 [.97-5.40] |
| Antidepressants* | 15 (8.9) | 13 (3.5) | .009 | 2.70 [1.26-5.81] |
| Benzodiazepins* | 6 (3.6) | 4 (1.1) | .05 | 3.40 [.95-12.21] |
| Parinson’s desease drugs* | 6 (3.6) | 3 (.8) | .05 | 4.54 [1.12-18.39] |
| Proton pump inhibitors* |
16 (9.5) |
14 (3.8) |
.007 |
2.68 [1.28-5.64] |
* Only Data from N = 539 could be analysed
Participants with dizziness had more often problems in walking 500m, a low physical activity, falls within the last six months, two and more points in the short-GDS and four and more medications. They took more frequent thyroid agents (OR = 1.67), anti-dementia drugs (OR = 2.29) antidepressants (OR = 2.70), benzodiazepines (OR = 3.40), Parkinson’s disease drugs (OR = 4.54) and proton pump inhibitors (OR = 2.68). According to all other kind of medication no significant differences could be found.
Dizziness and falls
The significance of predictors of dizziness was tested in terms of falls within the last six months. 107 (17.2%) of the participants reported falls within the last six months. We found a remarkable congruence of many predictors, especially of the functional parameters. For a better visualisation and overview of the results see table 4.
Table 4.
Significance of characteristics of participants (N=620) with dizziness (n=181) and falls (n=107) in the last 6 months according to table 1 and 2
| Characteristic | Dizziness | Falls |
|---|---|---|
| Sociodemographic | ||
| Age > 80 years | ** | ** |
| Female | ** | ** |
| Living alone | ** | ** |
| Education < 10 y | ||
| Health related | ||
| Shortsight glasses | * | |
| Reading glasses | ||
| Varifocals | * | |
| Poor and very poor health status (self rated) | ** | ** |
| Cardiovascular disease | * | |
| Diabetes mellitus | ||
| Osteoporosis | * | |
| Parkinson’s disease | * | |
| Depression (self report) | ** | ** |
| Sleep disorder | ** | ** |
| Hip joint endoprosthesis | ** | ** |
| Incontinence | ** | ** |
| Disturbance of memory | ** | * |
| BMI < 20 or > 30 | * | |
| 3 and more medical conditions | ** | ** |
| 4 and more medications taken | ** | |
| Functional | ||
| Fear of falling | ** | ** |
| Walker | ** | ** |
| Problems in getting up from bed | ** | ** |
| Problems with inhouse mobility | ||
| Problems in getting out |
** |
** |
*p<.05, **p<.01
Discussion
We found in our sample of community dwelling people aged 65 and over a 29.2% prevalence of dizziness within the last six months. This result was similar to that in previous community-based studies (1, 2, 3, 5, 20). In our study a distinctive age dependence appeared. Women were involved more often than men and this effect was independent of age, number of the diseases and drugs. The reasons for that are unclear. Participants with cardiovascular disease suffered significantly more often from dizziness than those without. This might be explained by the age dependent increase of orthostatic hypotension as well as arterial hypertension (21). In addition many heart circulation drugs cause dizziness. The intake of 4 and more drugs was connected with a more frequent incidence of dizziness. It is still unclear, whether the medications or the respective diseases or both caused dizziness.
Similarly, depression is associated with dizziness, although the causation is not clear. It is well known, that persons with depressions often suffer from dizziness (16, 22). Our results showed, that depression and the intake of antidepressant as well are associated with dizziness.
Further predictors were Parkinson’s disease, sleep disorders, osteoporosis, incontinence, hip joint endoprosthesis, shortsightednes (defined by glasses), being under- or overweight.
The frequency of dizziness increases with the number of the medical conditions. Comorbidity plays an important role in the self rated health status, which was a strong predictor for dizziness. This leads to the assumption of a multifactorial etiology of dizziness in the older persons.
We found a broad distribution of duration, period and frequency of dizziness. Dizziness lasted seconds in 48.9% of the cases, minutes to hours in 51.1%. In 68.6% it occurred daily or weekly, in the remaining cases only once a month, which shows the impact of dizziness on daily life. In 56.2% the symptoms persisted for 2 months or longer, in 43.8% shorter than 2 months.
Drachmann (18, 19) classified dizziness into 4 categories in order to roughly identify etiologies and to guide diagnostic procedures: losing balance while walking occurs in participants with gait disturbances, feeling near faint or pre-syncope in those with an underlying cardiovascular condition and vertigo indicates a vestibular dysfunction like benign paroxysmal positional vertigo (BPPV).
Pre-syncope is most often described as lightheaded or feeling faint. Syncope, by contrast, is actually fainting. Pre-syncope, or lightheadedness, does not result from primary central nervous system pathology. Nor does it originate in the inner ear. It is most often cardiovascular in etiology. In many patients, lightheadedness is a symptom of orthostatic hypotension. Orthostatic hypotension occurs when the blood pressure drops significantly when the patient stands from a supine position (45.9%). If loss of consciousness occurs in this situation, it is termed syncope.
A feeling of near faintness was however experienced by only 11.4%, although this feeling is the hallmark symptom of cardiovascular disorders. This demonstrates that in the old popula-tion the underlying condition is not always reflected in its distinctive symptom.
The majority of participants with dizziness described their problem as a feeling of loosing balance (64.5%). This depiction enhances the significance of the association of gait disturbances and dizziness in older persons. Dizziness may result in gait disturbances and represents a main risk factor for falls (23), on the other hand motor disabilities are described as a sensation of dizziness by many old people. Aside from this, a close causal relationship is very likely because parameters concomitant with gait disturbances are also strongly associated with dizziness: standing up or walking with difficulty, use of walking aids and particularly the occurrence of falls, which in older age are commonly precipitated by gait disturbances (24, 25). The association between dizziness and gait disturbances in our study is also seen in the overlapping features and predictors of falls and dizziness. Dizziness is on the one hand an important risk factor for falls, on the other hand are many older people after the experience of a fall insecure and frightened of walking and describe their sensations as dizziness. Our results suggest a third explanation according to which dizziness and falls are caused by identical multiple risk factors. In our study, comorbidity, a poor self rated health status and gait disturbances together give rise to dizziness and the occurrence of falls.
Similar to falls, the etiology of dizziness in the old population is mostly multifactorial. This is confirmed by the fact that the majority of participants (59.7%) are able to distinguish several triggering positions.
Future therapeutic interventions should bear in mind the probable multifactorial etiology of dizziness in the old population and be proposed accordingly, especially since monocausal therapies have so far shown only limited results.
The validity of our study is limited by the lack of technical examinations, which possibly would have discovered diseases associated with dizziness, for example postural hypotension or cardiac arrhythmias. It is further limited by the absence of any assessment of motor ability. Our paper is based however on a representative random survey of the population in contrast to most studies which only look into the prevalence and risk factors of a selected sample of the old population.
Our study showed, that dizziness is an important predictor for serious health problems, such as falls, gait disorders and a poor health status. Therefore older people should be asked in the medical examination, if they have symptoms of dizziness. If so, we suggest asking them, what special kinds of sensations they have. This would prompt the clinician to undertake special tests and assessment. For example vertigo may be caused by a lesion anywhere in the labyrinth or its CNS connections. Furthermore what activities or positions are associated with dizziness should be asked about.
Conclusion
Dizziness is a frequent syndrome in a population of community dwelling older people. In a prospective cohort study we could find predictors for dizziness out of medical, sociodemographic as well as of functional variables: comorbidity, poor subjective health, being female, increasing age and restrictions in mobility. Most of the participants reported daily or at least weakly episodes of dizziness. This emphasizes the importance of dizziness for every-day life. Gait disturbances seem to be an important causative factor for dizziness in persons at higher age. In analyzing our data we found dizziness developing from multifactorial causes, a finding that is very common with geriatric syndromes. Therefore the centre of interest for developing therapeutic interventions should be also multidimensional.
* Members of the IZG Study Group: Participating centres and investigators (alphabetical by centre): Carl-Korth-Institute, Erlangen: Lang, E.; Chair for Health Management, FAU Erlangen-Nuremberg: Schöffski, O.; Chair of Internal Medicine V and Institute of Biomedicine of Aging, FAU Erlangen-Nuremberg: Mühlberg, W., Sieber, C.; Clinic for Geriatric Medicine, Waldkrankenhaus St. Marien, Erlangen: Gaßmann, K.-G.; Clinic for Neurology, FAU Erlangen-Nuremberg: Kolominsky-Rabas, P.; Clinic for Psychiatry and Psychotherapy, FAU Erlangen-Nuremberg: Gräßel, E., Kornhuber, J.; Department of Management, FAU Erlangen-Nuremberg: Esslinger, A.S.; Institute of History and Ethics in Medicine, FAU Erlangen-Nuremberg: Wittern-Sterzel, R.; Institute of Psychogerontology, FAU Erlan-gen-Nuremberg: Ackermann, A., Engel, S., Kaiser, Η.-J., Lang, F.R., Oswald, W.D., Rupprecht, R., Schüssel, K.; Institute of Sport Sciences, FAU Erlangen-Nuremberg: Freiberger, E., Pfeifer, Κ., Rütten, A; Members without affiliation: Schneider, H., Stosberg, M.
Financial disclosure: None of the authors had any financial interest or support for this paper.
References
- 1.Boult C., Murphy J., Sloane P., Mor V., Drone C. The relation of dizziness to functional decline. J Am Geriatr Soc. 1991;39:858–861. doi: 10.1111/j.1532-5415.1991.tb04451.x. PubMed PMID: 1885859. [DOI] [PubMed] [Google Scholar]
- 2.Colledge N.R., Wilson J.A., MacIntyre C.C., MacLennan W.J. The prevalence and characteristics of dizziness in an elderly community. Age Ageing. 1994;23:17–20. doi: 10.1093/ageing/23.2.117. 10.1093/ageing/23.2.117 [DOI] [PubMed] [Google Scholar]
- 3.Ensrud K.E., Nevitt M.C., Yunis C., Hulley S.B., Grimm R.H., Cummings S.R. Postural hypotension and postural dizziness in elderly women. Arch Intern Med. 1992;152:1058–1064. 10.1001/archinte.152.5.1058 PubMed PMID: 1580709. [PubMed] [Google Scholar]
- 4.Sloane P., Blazer D., George L.K. Dizziness in a community elderly population. J Am Geriatr Soc. 1989;37:101–108. doi: 10.1111/j.1532-5415.1989.tb05867.x. PubMed PMID: 2783432. [DOI] [PubMed] [Google Scholar]
- 5.Tilvis R.J., Hakula S.M., Valvanne J., Erkinjuntti T. Postural hypotension and dizziness in a gen-eral aged population: a four-year follow-up of the Helsinki Aging Study. J Am Geriatr Soc. 1996;44:809–814. doi: 10.1111/j.1532-5415.1996.tb03738.x. PubMed PMID: 8675929. [DOI] [PubMed] [Google Scholar]
- 6.Ensrud K.E., Nevitt M.C., Yunis C., Cauley J.A., Seeley D.G., Fox K.M., et al. Correlates of impaired function in older women. J Am Geriatr Soc. 1994;42:481–489. doi: 10.1111/j.1532-5415.1994.tb04968.x. PubMed PMID: 8176141. [DOI] [PubMed] [Google Scholar]
- 7.Grimby A., Rosenhall U. Health-related quality of life and dizziness in old age. Gerontology. 1995;41:286–298. doi: 10.1159/000213696. 10.1159/000213696 PubMed PMID: 8537013. [DOI] [PubMed] [Google Scholar]
- 8.Grimley E.J. Transient neurological dysfunction and risk of stroke in an elderly English population: the different significance of vertigo and nonrotatory dizziness. Age Ageing. 1990;19:43–49. doi: 10.1093/ageing/19.1.43. 10.1093/ageing/19.1.43 [DOI] [PubMed] [Google Scholar]
- 9.Sixt E., Landahl S. Postural disturbances in a 75-year old population: I. Prevalence and functional consequences. Age Ageing. 1987;16:393–398. doi: 10.1093/ageing/16.6.393. 10.1093/ageing/16.6.393 PubMed PMID: 3425486. [DOI] [PubMed] [Google Scholar]
- 10.Kroenke K., Lucas C.A., Rosenberg M.L., Scherokman B., Herbers J.E., Wehrle P.A., et al. Causes of persistent dizziness. A prospective study of 100 patients in ambulatory care. Ann Intern Med. 1992;117:898–904. doi: 10.7326/0003-4819-117-11-898. PubMed PMID: 1443950. [DOI] [PubMed] [Google Scholar]
- 11.Davis L.E. Dizziness in elderly men. J Am Geriatr Soc. 1994;42:1184–1188. doi: 10.1111/j.1532-5415.1994.tb06986.x. PubMed PMID: 7963205. [DOI] [PubMed] [Google Scholar]
- 12.Katsarkas A. Dizziness in aging: a retrospective study of 1194 cases. Otolaryngol Head Neck Surg. 1994;110:296–301. doi: 10.1177/019459989411000306. 10.1016/S0194-5998(94)70772-3 PubMed PMID: 8134140. [DOI] [PubMed] [Google Scholar]
- 13.Lawson J., Fitzgerald J., Birchall J., Aldren C.P., Kenny R.A. Diagnosis of geriatric patients with severe dizziness. J Am Geriatr Soc. 1999;47:12–17. doi: 10.1111/j.1532-5415.1999.tb01895.x. PubMed PMID: 9920224. [DOI] [PubMed] [Google Scholar]
- 14.McIntosh S., DaCosta D., Kenny R.A. Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a “syncope” clinic. Age Ageing. 1993;22:53–58. doi: 10.1093/ageing/22.1.53. 10.1093/ageing/22.1.53 PubMed PMID: 8438668. [DOI] [PubMed] [Google Scholar]
- 15.Colledge N.R., Barr-Hamilton R.M., Lewis S.J., Sellar R.J., Wilson J.A. Evaluation of investigations to diagnose the cause of dizziness in elderly people: a community based controlled study. BMJ. 1996;313:788–792. doi: 10.1136/bmj.313.7060.788. PubMed PMID: 8842072. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Sloane P.D., Hartman M., Mitchell C.M. Psychological factors associated with chronic dizziness in patients aged 60 and older. J Am Geriatr Soc. 1994;42:847–852. doi: 10.1111/j.1532-5415.1994.tb06556.x. PubMed PMID: 8046194. [DOI] [PubMed] [Google Scholar]
- 17.Goring H., Baldwin R., Marriott A., Pratt H., Roberts C. Validation of short screening tests for depression and cognitive impairment in older medically ill inpatients. Int J Geriatr Psychiatry. 2004;19:465–471. doi: 10.1002/gps.1115. 10.1002/gps.1115 PubMed PMID: 15156548. [DOI] [PubMed] [Google Scholar]
- 18.Drachman D.A. In: Current Diagnosis in Neurology. Feldmann E., editor. Mosby-Year Book; St. Louis: 1994. Dizziness; pp. 264–270. [Google Scholar]
- 19.Drachman D.A. A 69-year-old man with chronic dizziness. JAMA. 1998;280:2111–2118. doi: 10.1001/jama.280.24.2111. 10.1001/jama.280.24.2111 PubMed PMID: 9875880. [DOI] [PubMed] [Google Scholar]
- 20.Tinetti M.E., Williams C., Gill T. Dizziness among older adults: a possible geriatric syndrome. Ann Intern Med. 2000;132:337–344. doi: 10.7326/0003-4819-132-5-200003070-00002. PubMed PMID: 10691583. [DOI] [PubMed] [Google Scholar]
- 21.Frishman W.H., Azer V., Sica D. Drug treatment of orthostatic hypotension and vasovagal syncope. Heart Dis. 2003;5(1):49–64. doi: 10.1097/01.HDX.0000050416.53995.43. 10.1097/01.HDX.0000050416.53995.43 PubMed PMID: 12549988. [DOI] [PubMed] [Google Scholar]
- 22.Drachman D.A., Hart C.W. An approach to the dizzy patient. Neurology. 1972;22:323–334. doi: 10.1212/wnl.22.4.323. PubMed PMID: 4401538. [DOI] [PubMed] [Google Scholar]
- 23.Gassmann KG, Rupprecht R, Freiberger E. Predictors for occasional and recurrent falls in older community dwelling people. Submitted to Z Gerontol Geriatr. [DOI] [PubMed]
- 24.Montero-Odasso M., Schapira M., Duque G., Soriano E.R., Kaplan R., Camera L.A. Gait disorders are associated with non-cardiovascular falls in elderly people: a preliminary study. BMC Geriatr. 2005;5:15. doi: 10.1186/1471-2318-5-15. 10.1186/1471-2318-5-15 PubMed PMID: 16321159. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 25.Stalenhoef P.A., Diederiks J.P., Knottnerus J.A., Kester A.D., Crebolder H.F. A risk model for the prediction of recurrent falls in community-dwelling elderly: a prospective cohort study. J Clin Epidemiol. 2002;55:1088–1094. doi: 10.1016/s0895-4356(02)00502-4. 10.1016/S0895-4356(02)00502-4 PubMed PMID: 12507672. [DOI] [PubMed] [Google Scholar]