Identifying Key Risk Factors for Dizziness Handicap in Middle-Aged and Older People.

Objectives: More than 10% of people aged 50 years and older report dizziness. Despite available treatments, dizziness remains unresolved for many people due in part to suboptimal assessment. We aimed to identify factors associated with dizziness handicap in middle-aged and older people to identify targets for intervention to address this debilitating problem. A secondary aim was to determine whether factors associated with dizziness differed between middle-aged (<70 years) and older people (>= 70 years). Design: Secondary analysis of baseline and prospective data from a randomized controlled trial. Setting and participants: In total, 305 individuals aged 50 to 92 years reporting significant dizziness in the past year were recruited from the community. Methods: Participants were classified as having either mild or no dizziness handicap (score<31) or moderate/ severe dizziness handicap (score: 31.100) based on the Dizziness Handicap Inventory. Participants completed health questionnaires and underwent assessments of psychological well-being, lying and standing blood pressure, vestibular function, strength, vision, proprioception, processing speed, balance, stepping, and gait. Participants reported dizziness episodes in monthly diaries for 6 months following baseline assessment. Results: Dizziness Handicap Inventory scores ranged from 0 to 86 with 95 participants (31%) reporting moderate/severe dizziness handicap. Many vestibular, cardiovascular, psychological, balance-related, and medical/medications measures were significantly associated with dizziness handicap severity and dizziness episode frequency. Binary logistic regression identified a positive Dix Hallpike/head-roll test for benign paroxysmal positional vertigo [odds ratio (OR) 2.09, 95% confidence interval (CI) (1.11.3.97)], cardiovascular medication use [OR 1.90, 95% CI (1.09.3.32)], high postural sway when standing on the floor with eyes closed (sway path >= 160 mm) [OR 2.97, 95% CI (1.73.5.10)], and anxiety (Generalized Anxiety Disorder Scale 7-item Scale score >= 8) [OR 3.08, 95% CI (1.36.6.94)], as significant and independent predictors of moderate/severe dizziness handicap. Participants aged 70 years and over were significantly more likely to report cardiovascular conditions than those aged less than 70 years old. Conclusions and implications: Assessments of cardiovascular conditions and cardiovascular medication use, benign paroxysmal positional vertigo, anxiety, and postural sway identify middle-aged and older people with significant dizziness handicap. A multifactorial assessment including these factors may assist in tailoring evidence-based therapies to alleviate dizziness handicap in this group. (C) 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.