Limits...
A Different Approach of Dizziness in Older Patients: Away from the Diagnostic Dance between Patient and Physician.

Maarsingh OR, Stam H, van der Horst HE - Front Med (Lausanne) (2014)

Bottom Line: Although the etiology of dizziness in older patients differs significantly from that of younger patients, most guidelines on dizziness advocate the same diagnosis-oriented approach for all patients regardless of their age.However, this diagnosis-oriented approach may be insufficient for older patients presenting with dizziness in general practice, because (1) general practitioners are often not able to identify an underlying cause of dizziness, (2) general practitioners regularly identify causes of dizziness that cannot be treated, and (3) general practitioners may identify causes of dizziness for which treatment is available but not desirable.This approach may enable general practitioners to improve their care for a voluminous group of impaired older patients, even if a diagnosis is not available (yet).

View Article: PubMed Central - PubMed

Affiliation: Department of General Practice and Elderly Care Medicine, VU University Medical Center , Amsterdam , Netherlands ; EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , Netherlands.

ABSTRACT
Although the etiology of dizziness in older patients differs significantly from that of younger patients, most guidelines on dizziness advocate the same diagnosis-oriented approach for all patients regardless of their age. However, this diagnosis-oriented approach may be insufficient for older patients presenting with dizziness in general practice, because (1) general practitioners are often not able to identify an underlying cause of dizziness, (2) general practitioners regularly identify causes of dizziness that cannot be treated, and (3) general practitioners may identify causes of dizziness for which treatment is available but not desirable. In this article, the authors present a simultaneous diagnosis- and prognosis-oriented approach for older dizzy patients. This approach may enable general practitioners to improve their care for a voluminous group of impaired older patients, even if a diagnosis is not available (yet).

No MeSH data available.


Related in: MedlinePlus

Schematic representation of current and suggested approach of chronic dizziness in older patients in general practice (D, diagnosis-oriented phase; P, prognosis-oriented phase).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4291845&req=5

Figure 1: Schematic representation of current and suggested approach of chronic dizziness in older patients in general practice (D, diagnosis-oriented phase; P, prognosis-oriented phase).

Mentions: For the clinical approach of chronic dizziness in older patients in primary care, we would like to suggest to replace the current “serial connection” between diagnosis and prognosis by a “parallel connection,” i.e., the diagnosis-oriented phase and prognosis-oriented phase start at the same time (see Figure 1). Currently, GPs are used to focus on prognosis after diagnosing a specific disease, for example, investigating the presence of albuminuria – as a marker for kidney disease – after diagnosing diabetes mellitus. In other words, the prognosis-oriented phase (“is this patient at risk of an unfavorable outcome and, if so, how to improve this outcome?”) follows the diagnosis-oriented phase (“what is the underlying cause of the presented complaint?”). We believe that the suggested “parallel connection” of diagnosis and prognosis is crucial for older dizzy patients in primary care, because many older dizzy patients remain undiagnosed but have clues for impairment reduction (3, 13, 14).


A Different Approach of Dizziness in Older Patients: Away from the Diagnostic Dance between Patient and Physician.

Maarsingh OR, Stam H, van der Horst HE - Front Med (Lausanne) (2014)

Schematic representation of current and suggested approach of chronic dizziness in older patients in general practice (D, diagnosis-oriented phase; P, prognosis-oriented phase).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4291845&req=5

Figure 1: Schematic representation of current and suggested approach of chronic dizziness in older patients in general practice (D, diagnosis-oriented phase; P, prognosis-oriented phase).
Mentions: For the clinical approach of chronic dizziness in older patients in primary care, we would like to suggest to replace the current “serial connection” between diagnosis and prognosis by a “parallel connection,” i.e., the diagnosis-oriented phase and prognosis-oriented phase start at the same time (see Figure 1). Currently, GPs are used to focus on prognosis after diagnosing a specific disease, for example, investigating the presence of albuminuria – as a marker for kidney disease – after diagnosing diabetes mellitus. In other words, the prognosis-oriented phase (“is this patient at risk of an unfavorable outcome and, if so, how to improve this outcome?”) follows the diagnosis-oriented phase (“what is the underlying cause of the presented complaint?”). We believe that the suggested “parallel connection” of diagnosis and prognosis is crucial for older dizzy patients in primary care, because many older dizzy patients remain undiagnosed but have clues for impairment reduction (3, 13, 14).

Bottom Line: Although the etiology of dizziness in older patients differs significantly from that of younger patients, most guidelines on dizziness advocate the same diagnosis-oriented approach for all patients regardless of their age.However, this diagnosis-oriented approach may be insufficient for older patients presenting with dizziness in general practice, because (1) general practitioners are often not able to identify an underlying cause of dizziness, (2) general practitioners regularly identify causes of dizziness that cannot be treated, and (3) general practitioners may identify causes of dizziness for which treatment is available but not desirable.This approach may enable general practitioners to improve their care for a voluminous group of impaired older patients, even if a diagnosis is not available (yet).

View Article: PubMed Central - PubMed

Affiliation: Department of General Practice and Elderly Care Medicine, VU University Medical Center , Amsterdam , Netherlands ; EMGO Institute for Health and Care Research, VU University Medical Center , Amsterdam , Netherlands.

ABSTRACT
Although the etiology of dizziness in older patients differs significantly from that of younger patients, most guidelines on dizziness advocate the same diagnosis-oriented approach for all patients regardless of their age. However, this diagnosis-oriented approach may be insufficient for older patients presenting with dizziness in general practice, because (1) general practitioners are often not able to identify an underlying cause of dizziness, (2) general practitioners regularly identify causes of dizziness that cannot be treated, and (3) general practitioners may identify causes of dizziness for which treatment is available but not desirable. In this article, the authors present a simultaneous diagnosis- and prognosis-oriented approach for older dizzy patients. This approach may enable general practitioners to improve their care for a voluminous group of impaired older patients, even if a diagnosis is not available (yet).

No MeSH data available.


Related in: MedlinePlus