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17. Prognosis and Survival of Older Patients With Dizziness in Primary Care: A 10-Year Prospective Cohort Study

Author

van Vugt, Vincent A., Bas, Gulsun, van der Wouden, Johannes C., Dros, Jacquelien, van Weert, Henk C.P.M., Yardley, Lucy, Twisk, Jos W.R., van der Horst, Henriette E., and Maarsingh, Otto R.

Subjects
Elderly patients -- Prognosis -- Care and treatment, Dizziness -- Patient outcomes -- Care and treatment -- Prognosis, Primary health care -- Patient outcomes, Health, Science and technology
Abstract

PURPOSE The prognosis of older patients with dizziness in primary care is unknown. Our objective was to determine the prognosis and survival of patients with different subtypes and causes of dizziness. METHODS In a primary care prospective cohort study, 417 older adults with dizziness (mean age 79 years) received a full diagnostic workup in 2006-2008. A panel of physicians classified the subtype and primary cause of dizziness. Main outcome measures were mortality and dizziness-related impairment assessed at 10-year follow-up. RESULTS At 10-year follow-up 169 patients (40.5%) had died. Presyncope was the most common dizziness subtype (69.1%), followed by vertigo (41.0%), disequilibrium (39.8%), and other dizziness (1.7%). The most common primary causes of dizziness were cardiovascular disease (56.8%) and peripheral vestibular disease (14.4%). Multivariable adjusted Cox models showed a lower mortality rate for patients with the subtype vertigo compared with other subtypes (hazard ratio [HR] = 0.62; 95% CI, 0.40-0.96), and for peripheral vestibular disease vs cardiovascular disease as primary cause of dizziness (HR = 0.46; 95% CI, 0.25-0.84). After 10 years, 47.7% of patients who filled out the follow-up measurement experienced substantial dizziness-related impairment. No significant difference in substantial impairment was seen between different subtypes and primary causes of dizziness. CONCLUSIONS The 10-year mortality rate was lower for the dizziness subtype vertigo compared with other subtypes. Patients with dizziness primarily caused by peripheral vestibular disease had a lower mortality rate than patients with cardiovascular disease. Substantial dizziness-related impairment in older patients with dizziness 10 years later is high, and indicates that current treatment strategies by family physicians may be suboptimal. Key words: aged; dizziness; family practice; mortality; vertigo, INTRODUCTION Dizziness is a common problem among older patients in primary care. (1) The annual prevalence of dizziness in adults ranges from 20% to 30% in population-based questionnaire studies. (2) [...]

Published
2020
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33. Association of Vulnerability Screening on Hospital Admission with Discharge to Rehabilitation-Oriented Care after Acute Hospital Stay.

Author

de Groot, Aafke J., Wattel, Elizabeth M., van Balen, Romke, Hertogh, Cees M. P. M., and van der Wouden, Johannes C.

Subjects
HOSPITAL admission & discharge, REHABILITATION centers, ELDER care, GERIATRICS, ACCIDENTAL falls in old age
Abstract

Background: The short Dutch Safety Management Screening (DSMS) is applied at hospital admission of all patients aged >70 years to assess vulnerability. Screening of four geriatric domains aims to prevent adverse outcomes and may support targeted discharge planning for post-acute care. We explored whether the DSMS criteria for acutely admitted patients were associated with rehabilitation-oriented care needs. Methods: This retrospective cohort study included community-dwelling patients aged ≥70 years acutely admitted to a tertiary hospital. We recorded patient demographics, morbidity, functional status, malnutrition, fall risk, and delirium and used descriptive analysis to calculate the risks by comparing the discharge destination groups. Results: Among 491 hospital discharges, 349 patients (71.1%) returned home, 60 (12.2%) were referred for geriatric rehabilitation, and 82 (16.7%) to other inpatient post-acute care. Non-home referrals increased with age from 21% (70-80 years) to 61% (>90 years). A surgical diagnosis (odds ratio [OR]=4.92; 95% confidence interval [CI], 2.03-11.95), functional decline represented by Katz-activities of daily living positive screening (OR=3.79; 95% CI, 1.76-8.14), and positive fall risk (OR=2.87; 95% CI, 1.31-6.30) were associated with non-home discharge. The Charlson Comorbidity Index did not differ significantly between the groups. Conclusion: Admission diagnosis and vulnerability screening outcomes were associated with discharge to rehabilitation-oriented care in patients >70 years of age. The usual care data from DSMS vulnerability screening can raise awareness of discharge complexity and provide opportunities to support timely and personalized transitional care. [ABSTRACT FROM AUTHOR]

Published
2023
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34. Predicting an Unfavorable Course of Dizziness in Older Patients

Author

Stam, Hanneke, Maarsingh, Otto R., Heymans, Martijn W., van Weert, Henk C.P.M., van der Wouden, Johannes C., and van der Horst, Henriette E.

Subjects
Aged patients -- Care and treatment -- Prognosis, Primary health care -- Methods -- Demographic aspects, Dizziness -- Diagnosis -- Demographic aspects -- Prognosis -- Care and treatment, Health, Science and technology
Abstract

PURPOSE Because dizziness in older people is often chronic and can substantially affect daily functioning, it is important to identify those at risk for an unfavorable course of dizziness to optimize their care. We aimed to develop and externally validate a prediction model for an unfavorable course of dizziness in older patients in primary care, and to construct an easy-to-use risk prediction tool. METHODS We used data from 2 prospective cohorts: a development cohort with 203 patients aged 65 years or older who consulted their primary care physician for dizziness and had substantial dizziness-related impairment (Dizziness Handicap Inventory [DHI] [greater than or equal to]), and a validation cohort with 415 patients aged 65 years or older who consulted their primary care physician for dizziness of any severity. An unfavorable course was defined as presence of substantial dizziness-related impairment (DHI [greater than or equal to]) after 6 months. RESULTS Prevalence of an unfavorable course of dizziness was 73.9% in the development cohort and 43.6% in the validation cohort. Predictors in the final model were the score on the screening version of the DHI, age, history of arrhythmia, and looking up as a provoking factor. The model showed good calibration and fair discrimination (area under the curve = 0.77). On external validation, discriminative ability remained stable (area under the curve = 0.78). The constructed risk score was strongly correlated with the prediction model. Performance measures for risk score cut-off values are presented to determine the optimal cut-off point for clinical practice. CONCLUSIONS We developed an easy-to-use risk score for dizziness-related impairment in primary care. The risk score, consisting of only 4 predictors, will help primary care physicians identify patients at high risk for an unfavorable course of dizziness. Key words: dizziness; older adults; risk prediction; risk factors; falls; geriatrics; practice-based research; primary care, INTRODUCTION One out of 10 older patients visits their primary care physician at least once a year because of dizziness. (1,2) Dizziness strongly affects daily functioning in older adults (3-6) [...]

Published
2018
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38. Effectiveness of psychosomatic therapy for patients with persistent somatic symptoms:Results from the CORPUS randomised controlled trial in primary care

Author

Wortman, Margreet S.H., van der Wouden, Johannes C., Twisk, Jos W.R., Visser, Bart, Assendelft, Willem J.J., van der Horst, Henriëtte E., Olde Hartman, Tim C., General practice, APH - Aging & Later Life, APH - Quality of Care, Epidemiology and Data Science, APH - Health Behaviors & Chronic Diseases, APH - Methodology, APH - Mental Health, Lectoraat Oefentherapie, and Urban Vitality

Subjects
Psychiatry and Mental health, Clinical Psychology, All institutes and research themes of the Radboud University Medical Center, Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Abstract

ObjectiveTo evaluate the effectiveness of psychosomatic therapy versus care as usual in primary care for patients with persistent somatic symptoms (PSS).MethodsWe conducted a pragmatic, two-armed, randomised controlled trial among primary care patients with PSS in the Netherlands that included 39 general practices and 34 psychosomatic therapists. The intervention, psychosomatic therapy, consisted of 6–12 sessions delivered by specialised exercise- and physiotherapists. Primary outcome measure: patient's level of functioning. Secondary outcomes: severity of physical and psychosocial symptoms, health-related quality of life, health-related anxiety, illness behaviour and number of GP contacts.ResultsCompared to usual care (n = 85), the intervention group (n = 84) showed no improvement in patient's level of functioning (mean difference − 0.50 [95% CI -1.10 to 0.10]; p = .10), and improvement in health-related anxiety (mean difference − 1.93 [95% CI -3.81 to −0.04]; p = .045), over 12 months. At 5-month follow-up, we found improvement in physical functioning, somatisation, and health-related anxiety. The 12-month follow-up revealed no therapy effects. Subgroup analyses showed an overall effect in patient's level of functioning for the group with moderate PSS (mean difference − 0.91 [95% CI -1.78 to −0.03]; p = .042). In the year after the end of therapy, the number of GP contacts did not differ significantly between the two groups.ConclusionWe only found effects on some secondary outcome measures, and on our primary outcome measure especially in patients with moderate PSS, the psychosomatic therapy appears promising for further study.Trial registration: the trial is registered in the Netherlands Trial Registry, https://trialsearch.who.int/Trial2.aspx?TrialID=NTR7356 under ID NTR7356.

Published
2023

40. Key items for reports of primary care research: an international Delphi study

Author

Sturgiss, Elizabeth Ann, primary, Prathivadi, Pallavi, additional, Phillips, William R, additional, Moriarty, Frank, additional, Lucassen, Peter L B J, additional, van der Wouden, Johannes C, additional, Glasziou, Paul, additional, Olde Hartman, Tim C, additional, Orkin, Aaron, additional, Reeve, Joanne, additional, Russell, Grant, additional, and van Weel, Chris, additional

Published
2022
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