EVALUATION OF INVESTIGATIONS TO DIAGNOSE THE CAUSE OF DIZZINESS IN ELDERLY PEOPLE - A COMMUNITY-BASED CONTROLLED-STUDY

Objective-To compare the findings in dizzy elderly people with those i n controls of a similar age to identify which investigations different iate dizzy from non-dizzy patients and to design an investigational al gorithm. Design-Community based study of clinical and laboratory findi ngs in dizzy and control elderly people. Setting-Research outpatient c linic at a teaching hospital. Subjects-149 dizzy and 97 control subjec ts aged over 65 years recruited from a community survey and articles i n the local press. Main outcome measures-Findings on physical examinat ion, blood testing, electrocardiography (at rest and over 24 hours), e lectronystagmography, posturography, and magnetic resonance imaging of head and neck (125 (84%) dizzy subjects and 86 (89%) controls); hospi tal anxiety and depression score; responses to hyperventilation, carot id sinus massage, and the Hallpike manoeuvre. Results-Blood profile, e lectrocardiography, electronystagmography, and magnetic resonance imag ing failed to distinguish dizzy from control subjects because of the f requency of asymptomatic abnormalities in controls. Posturography and clinical assessment (physical examination, dizziness provocation, and psychological assessment) showed significant differences between the g roups. A cause of the dizziness was identified from clinical diagnosti c criteria based on accepted definitions in 143 subjects, with 126 hav ing more than one cause. The most common diagnoses were central vascul ar disease (105) and cervical spondylosis (98), often accompanied by p oor vision and anxiety. Conclusion-Expensive investigations are rarely helpful in dizzy elderly people. The cause of the dizziness can be di agnosed in most cases on the basis of a thorough clinical examination without recourse to hospital referral.