title: Causes of persistent dizziness in elderly patients in primary care.
abstract: OBJECTIVE
  Although dizzy patients are predominantly seen in primary care, most diagnostic studies on dizziness have been performed among patients in secondary or tertiary care. Our objective was to describe subtypes of dizziness in elderly patients in primary care and to assess contributory causes of dizziness.
  
  
  METHODS
  We performed a cross-sectional diagnostic study among elderly patients in the Netherlands consulting their family physician for persistent dizziness. All patients underwent a comprehensive evaluation according to a set of diagnostic tests that were developed during an international Delphi procedure. Data for each patient were independently reviewed by a panel consisting of a family physician, a geriatrician, and a nursing home physician, which resulted in major and minor contributory causes of dizziness.
  
  
  RESULTS
  From June 2006 to January 2008, we included 417 patients aged 65 to 95 years. Presyncope was the most common dizziness subtype (69%). Forty-four percent of the patients were assigned more than 1 dizziness subtype. Cardiovascular disease was considered to be the most common major contributory cause of dizziness (57%), followed by peripheral vestibular disease (14%), and psychiatric illness (10%). An adverse drug effect was considered to be the most common minor contributory cause of dizziness (23%). Sixty-two percent of the patients were assigned more than 1 contributory cause of dizziness.
  
  
  CONCLUSIONS
  Contrary to most previous studies, cardiovascular disease was found to be the most common major cause of dizziness in elderly patients in primary care. In one-quarter of all patients an adverse drug effect was considered to be a contributory cause of dizziness, which is much higher than reported in previous studies.
authors.affiliation: Department of Family Practice and EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands.
authors.forename: Otto R
authors.initials: OR
authors.lastname: Maarsingh
authors.forename: Jacquelien
authors.initials: J
authors.lastname: Dros
authors.forename: François G
authors.initials: FG
authors.lastname: Schellevis
authors.forename: Henk C
authors.initials: HC
authors.lastname: van Weert
authors.forename: Danielle A
authors.initials: DA
authors.lastname: van der Windt
authors.forename: Gerben
authors.initials: G
authors.lastname: ter Riet
authors.forename: Henriette E
authors.initials: HE
authors.lastname: van der Horst
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications; D003430:Cross-Sectional Studies; D003697:Delphi Technique; D003937:Diagnosis, Differential; D004244:Dizziness / Q000139:chemically induced / Q000453:epidemiology / Q000209:etiology*; D064420:Drug-Related Side Effects and Adverse Reactions; D005260:Female; D015577:Geriatric Assessment; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications; D009426:Netherlands / Q000453:epidemiology; D011320:Primary Health Care; D012307:Risk Factors; D013575:Syncope / Q000150:complications; D013997:Time Factors; D015837:Vestibular Diseases / Q000150:complications
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