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Lindell E, Odhagen E, Tuomi L. Living with dizziness impacts health-related quality of life among older adults. Laryngoscope Investig Otolaryngol 2024; 9:e1194. [PMID: 38362202 PMCID: PMC10866590 DOI: 10.1002/lio2.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 10/16/2023] [Accepted: 11/26/2023] [Indexed: 02/17/2024] Open
Abstract
Objective This study aimed to compare older adults reporting dizziness to those not reporting dizziness regarding health-related quality of life (HRQL), distress due to dizziness, and balance confidence. A secondary aim was to investigate potential association between HRQL, number of falls, balance confidence, and distress due to dizziness. Methods Patients coming for bone density measurements answered questions regarding occurrence of dizziness. Patients reporting dizziness on a daily or weekly basis were considered eligible and invited for investigation at the Ear, Nose and Throat clinic at Södra Älvsborg Hospital, Sweden. Patients not reporting dizziness were considered eligible as controls. All patients answered the Dizziness Handicap Inventory (DHI), Activity Balance Confidence Scale (ABC-scale), and Euro-QoL-5D-3L questionnaires. Results A total of 55 dizzy patients came for physical investigation and answered the questionnaires and 47 non-dizzy participants only answered the questionnaires. The dizzy participants reported lower levels of balance confidence, lower HRQL, more prior falls, and higher levels of distress due to dizziness than the non-dizzy controls. Lower levels of balance confidence and higher level of distress due to dizziness were each associated with lower HRQL. Conclusion Dizziness, unsteadiness, and low balance confidence are associated with HRQL in a negative way. This is important to consider when measuring HRQL in a senior population, since a sensation of unsteadiness may indirectly contribute to low HRQL together with other symptoms. Level of evidence 2b.
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Affiliation(s)
- Ellen Lindell
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Gothenburg, Sahlgrenska Academy, Institute of Clinical SciencesGothenburgSweden
- Department of OtorhinolaryngologyRegion Västra Götaland, Södra Älvsborg HospitalBoråsSweden
- Department of Research, Education and InnovationRegion Västra Götaland, Södra Älvsborg HospitalBoråsSweden
| | - Erik Odhagen
- Department of Otorhinolaryngology, Head and Neck SurgeryUniversity of Gothenburg, Sahlgrenska Academy, Institute of Clinical SciencesGothenburgSweden
- Department of OtorhinolaryngologyRegion Västra Götaland, Södra Älvsborg HospitalBoråsSweden
- Department of Research, Education and InnovationRegion Västra Götaland, Södra Älvsborg HospitalBoråsSweden
| | - Lisa Tuomi
- Institute of Neuroscience and Physiology, Speech and Language Pathology UnitUniversity of Gothenburg, Sahlgrenska AcademyGothenburgSweden
- Department of Otorhinolaryngology, Head and Neck SurgeryRegion Västra Götaland, Sahlgrenska University HospitalGothenburgSweden
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Licina S, Kjeken I, Førland O, Langeland E, Tuntland H. Exploring Goals and Functional Changes in Reablement for People with Fractures and People with Dizziness and Balance Problems. J Multidiscip Healthc 2023; 16:2323-2337. [PMID: 37601327 PMCID: PMC10439777 DOI: 10.2147/jmdh.s417883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 06/28/2023] [Indexed: 08/22/2023] Open
Abstract
Background Although older people often have challenges with fractures and dizziness/balance problems, knowledge concerning the impact of reablement of people with these conditions is limited. Aim To explore functional changes in reablement for older home-dwelling people with fractures and dizziness/balance problems regarding 1) occupational performance and satisfaction with performance, 2) physical function and 3) health-related quality of life, and 4) which occupations they prioritize as rehabilitation goals. Material and Methods The sample is derived from a nationwide clinically controlled trial in Norway consisting of 149 participants with fractures and 113 with dizziness/balance problems who participated in a four to 10-week reablement program. Data were collected at baseline and at 10-week, 6-month, and 12-month follow-up and were analyzed with paired t-tests and analysis of covariance. Occupational priorities were categorized into sub-areas of occupation. Results Both groups had significant short-, mid-, and long-term improvements in occupational performance and satisfaction with performance. Except for balance from baseline to 12-month follow-up, the fracture group showed significant improvements in physical function and health-related quality of life at all follow-ups. The results varied more in the group with dizziness/balance problems in physical function and health-related quality of life. Functional mobility was the highest prioritized occupational sub-area in both groups. Conclusion The findings of this study provide extended knowledge about goals and functional changes in people with fractures and dizziness/balance problems following a reablement program. Significance Tailoring and individual adjustments according to diagnosis may be important in person-centered care in reablement.
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Affiliation(s)
- Selma Licina
- Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Ingvild Kjeken
- Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
| | - Oddvar Førland
- Centre for Care Research Western Norway, Western Norway University of Applied Sciences, Bergen, Norway
| | - Eva Langeland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Hanne Tuntland
- Department of Occupational Therapy, Prosthetics and Orthotics, OsloMet - Oslo Metropolitan University, Oslo, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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Pauwels S, Casters L, Lemkens N, Lemmens W, Meijer K, Meyns P, van de Berg R, Spildooren J. Gait and Falls in Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-analysis. J Neurol Phys Ther 2023; 47:127-138. [PMID: 36897200 PMCID: PMC10521788 DOI: 10.1097/npt.0000000000000438] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023]
Abstract
BACKGROUND AND PURPOSE Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorders, and is treated effectively with particle repositioning maneuvers (PRM). The aim of this study was to assess the influence of BPPV and treatment effects of PRM on gait, falls, and fear of falling. METHODS Three databases and the reference lists of included articles were systematically searched for studies comparing gait and/or falls between (1) people with BPPV (pwBPPV) and controls and (2) pre- and posttreatment with PRM. The Joanna Briggs Institute critical appraisal tools were used to assess risk of bias. RESULTS Twenty of the 25 included studies were suitable for meta-analysis. Quality assessment resulted in 2 studies with high risk of bias, 13 with moderate risk, and 10 with low risk. PwBPPV walked slower and demonstrated more sway during tandem walking compared with controls. PwBPPV also walked slower during head rotations. After PRM, gait velocity during level walking increased significantly, and gait became safer according to gait assessment scales. Impairments during tandem walking and walking with head rotations did not improve. The number of fallers was significantly higher for pwBPPV than for controls. After treatment, the number of falls, number of pwBPPV who fell, and fear of falling decreased. DISCUSSION AND CONCLUSIONS BPPV increases the odds of falls and negatively impacts spatiotemporal parameters of gait. PRM improves falls, fear of falling, and gait during level walking. Additional rehabilitation might be necessary to improve gait while walking with head movements or tandem walking.Video Abstract available for more insights from the authors (see the Supplemental Digital Content Video, available at: http://links.lww.com/JNPT/A421 ).
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Affiliation(s)
- Sara Pauwels
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Laura Casters
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Nele Lemkens
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Winde Lemmens
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Kenneth Meijer
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Pieter Meyns
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Raymond van de Berg
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
| | - Joke Spildooren
- Faculty of Rehabilitation Sciences, REVAL-Rehabilitation Research Centre, Hasselt University, Diepenbeek, Belgium (S.P., L.C., P.M., J.S.); Department of Otorhinolaryngology and Head & Neck Surgery, School for Mental Health and Neuroscience, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center+, Maastricht, the Netherlands (S.P., R.v.d.B.); Department of Otorhinolaryngology, Head and Neck Surgery, ZOL Hospital, Genk, Belgium (N.L., W.L.); and Department of Nutrition and Movement Sciences, Maastricht University, Maastricht, the Netherlands (K.M.)
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Teggi R, Familiari M, Battista RA, Gatti O, Cangiano I, Bussi M, Bubbico L. The social problem of presbystasis and the role of vestibular rehabilitation in elderly patients: a review. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2023:1-8. [PMID: 37224169 PMCID: PMC10366565 DOI: 10.14639/0392-100x-n1908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 10/17/2022] [Indexed: 05/26/2023]
Affiliation(s)
- Roberto Teggi
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Marco Familiari
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Rosa Alessia Battista
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Omar Gatti
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Iacopo Cangiano
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology, Head and Neck Surgery, Scientific Institute of Hospitalization and Care San Raffaele Hospital, Vita - Salute University, Milan, Italy
| | - Luciano Bubbico
- Department of Sensorineural Disabilities, INAPP/Italian Institute of Social Medicine, Rome, Italy
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Prell T, Mendorf S, Axer H. Tolerance to Dizziness Intensity Increases With Age in People With Chronic Dizziness. Front Neurol 2022; 13:934627. [PMID: 35911923 PMCID: PMC9330066 DOI: 10.3389/fneur.2022.934627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/21/2022] [Indexed: 11/15/2022] Open
Abstract
Background Dizziness is a common complaint in older adults. To know which factors are instrumental in enabling patients with chronic dizziness to tolerate their symptoms to a certain degree in everyday life can help to develop tailored therapies. Methods Data from 358 patients with chronic dizziness and vertigo who had attended a multimodal daycare treatment program were recorded. Data included sociodemographic parameters, dizziness-related characteristics, the Vertigo Symptom Scale (VSS), and the Hospital Anxiety and Depression Scale (HADS). Descriptive statistics, elastic net regression, and mediation analysis were used. Results A higher tolerance of dizziness was associated with higher age, higher intensity of dizziness, lower burden of dizziness, higher HADS depression, structural reason for dizziness (type), permanent dizziness, absence of attacks, and longer disease duration. In contrast, younger persons with attack-like dizziness reported to tolerate less dizziness. Age had a significant direct effect on tolerance (72% of the total effect) and a significant indirect effect via intensity on tolerance (28% of the total effect) in the mediation analysis. Conclusion It can only be speculated that negative stereotypes about age-related complaints may play a role in this. Why older people tolerate more dizziness and to what extent this may contribute to lower healthcare utilization need to be investigated in further studies.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
- *Correspondence: Tino Prell ; orcid.org/0000-0002-6423-3108
| | - Sarah Mendorf
- Department of Neurology, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany
- Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
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Prell T, Finn S, Axer H. How Healthcare Utilization Due to Dizziness and Vertigo Differs Between Older and Younger Adults. Front Med (Lausanne) 2022; 9:852187. [PMID: 35252281 PMCID: PMC8889010 DOI: 10.3389/fmed.2022.852187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 01/26/2022] [Indexed: 11/21/2022] Open
Abstract
Background Vertigo and dizziness are common in older adults. We describe self-reported healthcare utilization because of dizziness and vertigo in older adults attending a tertiary care specialized vertigo center. Methods Data from 765 patients (45% were ≥60 years old) with chronic dizziness and vertigo who attended a daycare multimodal treatment program were recorded. Data included sociodemographic parameters, dizziness-related characteristics, the Body Sensations Questionnaire (BSQ), the Agoraphobic Cognitions Questionnaire (ACQ), and the Hospital Anxiety and Depression Scale (HADS). Also, healthcare utilization, including (1) physician and clinical services, (2) hospitalizations in the year before consulting the vertigo center, (3) prescription of drugs and other professional services were included. Descriptive statistics, exploratory data analysis, and regression models were used. Results Intensity of dizziness was similar in both age groups, however, distress due to dizziness was more severe in younger persons. Dizziness symptoms lasted longer in older adults than in younger persons. Older adults had a somatic diagnosis (74.6 vs. 35.0%) more frequently and reported more falls (37.2 vs. 28.5%) than younger individuals. Anxiety about bodily sensations was higher in younger patients (mean BSQ1 = 9.33 ± 5.6) than in older patients (mean BSQ1 = 6.72 ± 5.4). Older persons had fewer depressive symptoms (mean HADS depression = 5.8 ± 3.6 vs. 6.5 ± 4.1) and less anxiety (mean HADS anxiety = 5.7 ± 3.7 vs. 7.8 ± 4.1) than younger individuals. Younger people were more frequently hospitalized (24.4%) than older adults (16.3%) in the year before consulting the vertigo center. Also, younger patients and patients with non-somatic etiologies had considerably more consultations with healthcare providers than older patients. Older adults received less medication (50.3%), less physiotherapy (41%), and less psychological therapy (11.6%) for vertigo than younger people (59.7, 52.2, 20.4%, respectively). Conclusion Age-associated differences in healthcare utilization were defined in selected patients attending a specialized vertigo center. Since dizziness is frequently a heterogeneous disorder requiring interdisciplinary care, its diagnostic and therapeutic work-up must be improved for older patients with dizziness.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany
| | - Sigrid Finn
- Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Jena, Germany.,Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
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Prell T, Wassermann A, Zipprich HM, Finn S, Axer H. Impact of Common Dizziness Associated Symptoms on Dizziness Handicap in Older Adults. Front Neurol 2022; 12:801499. [PMID: 34975741 PMCID: PMC8718649 DOI: 10.3389/fneur.2021.801499] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 11/29/2021] [Indexed: 01/19/2023] Open
Abstract
Background: A cross-sectional observational study was designed to determine the impact of dizziness associated symptoms on the dizziness handicap inventory (DHI) in older adults (≥60 years). Methods: In total, 785 individuals referred to a multidisciplinary dizziness unit were assessed. Participants completed self-report questionnaires with general questions about symptoms of dizziness as well as the DHI. The DHI subscores (physical, functional, emotional) were calculated. Medical diagnoses were collected from the medical records of the patients. One-way MANOVA and networking analysis were used to analyze the impact of dizziness associated symptoms on dizziness handicap. Results: Most patients reported swaying dizziness (60.6%) and feeling of unsteadiness (59.8%) with substantial overlap between the types of dizziness. Most frequent dizziness associated symptoms were ear noise/tinnitus, visual problems, and nausea/vomiting. Network analysis revealed that visual disturbances, headache, and hearing impairment were associated with higher DHI and explained 12% of the DHI variance in the linear regression. In the one-way MANOVA visual problems and headache had an effect on all three DHI subscores, while hearing impairment was associated with the functional and emotional subscores of DHI. Conclusion: Distinct dizziness associated symptoms have substantial impact on dizziness handicap in older adults. A multifactorial assessment including these symptoms may assist in tailoring therapies to alleviate dizziness handicap in this group.
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Affiliation(s)
- Tino Prell
- Department of Geriatrics, Halle University Hospital, Halle, Germany.,Center for Healthy Ageing, Jena University Hospital, Jena, Germany
| | - Alexander Wassermann
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.,Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
| | - Hannah M Zipprich
- Center for Healthy Ageing, Jena University Hospital, Jena, Germany.,Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany
| | - Sigrid Finn
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.,Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
| | - Hubertus Axer
- Department of Neurology, Jena University Hospital, Friedrich Schiller University, Jena, Germany.,Center for Vertigo and Dizziness, Jena University Hospital, Jena, Germany
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