Family Practitioners’ Management of Older Patients with New-onset Dizziness
DOI: 10.3238/zfa.2011.0445german translation / full article
Background: Dizziness is one of the frequent complaints of older patients in primary care. In view of the diversity of possible aetiologies it was the aim of our study to analyse family practitioners’ (FPs’) diagnostic and therapeutic strategies in older patients with incident dizziness specifically.
Methods: Participants (n = 69, ? 65 years) complaining about new-onset dizziness present for less than 6 months were consecutively registered in 21 primary care practices. 6 months after the first consultation chart reviews and standardised face-to-face interviews with the FPs were performed to assess and descriptively analyse their management decisions.
Results: Most of the FPs performed cardiological and neurological examinations including the vestibular system. However, they left out tests for orthostatic dizziness and the Dix-Hallpike manoeuvre for benign paroxysmal positional vertigo (BPPV). A proportion of 44% of the patients were prescribed a specific drug for dizziness, other therapeutical interventions like physiotherapy were less frequently recommended. Only 1 of 8 patients suffering from BPPV was educated about the Epley manoeuvre.
Conclusion: Particularly with regard to the underestimated prevalence of BPPV in older patients, FPs should attach more importance to the examination of the vestibular system and to patient education about the therapeutically effective Epley (or: Semont) manoeuvre. Optimal diagnostic strategies in primary care and alternatives to pharmacotherapy concerning incident dizziness merit further investigation.