PSYCHOLOGICAL-FACTORS ASSOCIATED WITH CHRONIC DIZZINESS IN PATIENTS AGED 60 AND OLDER

OBJECTIVE: To identify the prevalence and character of psychological d isorders accompanying chronic dizziness in older patients. DESIGN: Cas e series of patients from a geriatric dizziness clinic, with compariso n data from age- and sex-matched healthy community controls. Both case s and controls received screening psychological testing; all cases wer e evaluated by a clinical psychologist as part of the dizziness clinic evaluation. SETTING: Multidisciplinary Geriatric Dizziness Clinic. PA RTICIPANTS: Fifty six consecutive patients with chronic dizziness, eva luated by a multidisciplinary Geriatric Dizziness Clinic, and 68 healt hy volunteers whose age and sex distribution matched that of the dizzi ness clinic patients. MEASUREMENTS: Standardized questionnaire for med ical, functional, and demographic data; the anxiety, depression, somat ization, and phobic anxiety subscales of the Symptom Checklist-90 (SCL -90-R); the Tinetti gait and motor screen; a physical therapy evaluati on; selected laboratory tests; evaluation by a geriatrician; and a for mal evaluation by a clinical psychologist, including a semistructured interview. Psychological diagnoses were assigned based on DSM-III-R cr iteria. MAIN RESULTS: Of these patients with chronic dizziness, 37.5 p ercent had a psychological diagnosis causing or contributing to their dizziness problem. Of these, only 3 were felt to have a primary psycho logical cause of their dizziness, and 18 had secondary psychological d iagnoses. Anxiety disorders, depression, and adjustment reactions were the most common diagnoses. On multivariate analysis, factors predicti ng a psychological diagnosis were a positive response to hyperventilat ion testing, a high score on the SCL-90 anxiety subscale, and fatigue as a precipitant of dizziness. In addition, dizziness clinic patients scored significantly higher (P < 0.001) on all 4 subscales of the SCL- 90 when compared with the healthy elderly, suggesting a greater degree of psychological distress among these elderly with chronic dizziness. CONCLUSIONS: Psychological disorders are rare as primary causes but a re common as contributing or modulating factors in older persons with dizziness.