title: Dizziness in older people: at risk of shared therapeutic nihilism between patient and physician. A qualitative study.
abstract: Dizziness-related impairment is a strong predictor for an unfavourable course of dizziness in older people. In this study we explored the experiences of older patients with significant dizziness-related impairment and their wishes and expectations regarding general practitioner (GP) care. Knowing the expectations and priorities of people with dizziness may enable the GP to provide tailor-made care, which in turn may substantially increase the quality of life and decrease the use and costs of health care.
  
  
  
  We conducted a qualitative study with semi-structured interviews. We selected patients from ten Dutch general practices. Patients were invited to participate in the study if they were ≥ 65 years, visited their GP because of dizziness and were significantly impaired due to dizziness (Dizziness Handicap Inventory ≥ 30). We applied content analysis to the semi-structured interviews.
  
  
  
  Thirteen participants participated, seven were female. Analysis of the interviews resulted in the overall theme "Dizziness in older people: at risk of shared therapeutic nihilism by the patient and the GP". Firstly, this can explained by the fact that participants frequently presented dizziness as a secondary complaint when they visited the GP for another complaint. Secondly, participants reported that the GP often could not help them with any treatment. Despite a poor therapeutic outcome, the vast majority of participants was satisfied how the GP handled their dizziness. Yet, understanding the cause of dizziness seems important for dizzy older patients.
  
  
  
  Despite significant dizziness-related impairment, older dizzy patients may not present dizziness as main reason for encounter. Presenting dizziness as a secondary complaint may give GPs the - wrong - impression that the dizziness-related impairment is only mild. GPs need to be aware of this potential underreporting. Knowing the cause of dizziness seems important for older patients. Yet, GPs regularly did not succeed in identifying the underlying cause of dizziness. Therefore, GPs should manage the expectations of older dizzy patients regarding diagnosis and successful treatment, by informing them about the uncertainty and unpredictability of dizziness. We also recommend GPs to focus on improving functional ability; this is the key to escape from therapeutic nihilism by the GP.
authors.affiliation: Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT, Amsterdam, The Netherlands. stam.h@vumc.nl.
authors.forename: Hanneke
authors.identifier: 0000-0001-5450-6830
authors.initials: H
authors.lastname: Stam
authors.affiliation: Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Marjanne
authors.initials: M
authors.lastname: Wisse
authors.affiliation: Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Bram
authors.initials: B
authors.lastname: Mulder
authors.affiliation: Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Johannes C
authors.initials: JC
authors.lastname: van der Wouden
authors.affiliation: Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Otto R
authors.initials: OR
authors.lastname: Maarsingh
authors.affiliation: Department of General Practice and Elderly Care Medicine and EMGO Institute for Health and Care Research, VU University Medical Center, 1081 BT, Amsterdam, The Netherlands.
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D004244:Dizziness / Q000150:complications* / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D005260:Female; D058006:General Practice; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D051346:Mobility Limitation; D017060:Patient Satisfaction; D036301:Qualitative Research
keywords: Aged; Dizziness; General practice; Impairment; Qualitative research