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Investigations to diagnose cause of dizziness in elderly people

BMJ 1997; 314 doi: (Published 18 January 1997) Cite this as: BMJ 1997;314:224

Clinical assessment in the surgery is not adequate

  1. Sarah Caine, Registrara,
  2. Margaret MacMahon, Consultanta
  1. a Care of the Elderly, Bristol Royal Infirmary, Bristol BS2 8HW
  2. b St Leonard's Medical Practice, NHS Research and Development Practice, Exeter EX1 1SF
  3. cCare of the Elderly, Liberton Hospital, Edinburgh EH16 6UB
  4. dUniversity of Newcastle, Newcastle upon Tyne NE7 7DN

    Editor-We do not agree with Nicki R Colledge and colleagues' recommendations to general practitioners that their study “should herald a shift away from protracted investigation programmes” for dizzy elderly patients or that a diagnosis can be made “without recourse to hospital referral.”1 Dizziness was provoked by standing in 63% of patients, and 39% had fallen, but the only specialist investigations undertaken were posturography, vestibular testing, and magnetic resonance imaging. The authors attributed dizziness to cervical spondylosis in 65% and to poor vision, anxiety, or hyperventilation in many others. Cervical spondylosis was diagnosed on clinical grounds only. It is common in elderly people, and the authors do not give the incidence among controls. Similarly, poor vision in a dizzy subject does not imply that visual impairment causes dizziness.

    The study does not include appropriate cardiovascular investigations. This is important when twice as many of the dizzy patients as controls had ischaemic heart disease and almost three times as many were taking vasodilator drugs. Orthostatic hypotension was diagnosed after only one minute's standing time. In elderly subjects an early temporary increase in arterial blood pressure when standing …

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