Dizziness in older patients in general practice: a diagnostic challenge

Horst, H.E. van der [Promotor]Schellevis, F.G. [Promotor]Weert, H.C.P.M. van [Copromotor

Reduction Of Dizziness in older people (RODEO)

Background: The management of dizziness in older patients is primarily diagnosis-oriented. However, in 40 % of older patients with dizziness, GPs are not able to identify an underlying cause, and a number of common underlying causes of dizziness cannot (or hardly) be treated. In this study we will investigate the effectiveness of a prognosis-oriented approach in the management of dizziness in older patients. This prognosis-oriented approach comprises identification of patients at risk for chronic dizziness with persistent impairment by identifying risk factors for an unfavourable course of dizziness. Patients at risk for chronic dizziness with persistent impairment will be offered treatment addressing the identified modifiable risk factors. Methods/Design: This study will be performed in primary care. An intervention study and a validation study will be conducted in a three-arm cluster randomised design. In the intervention study we will investigate a risk factor guided multi-component intervention. The risk factor guided intervention includes: (1) medication adjustment in case of three or more prescribed fall-risk-increasing drugs, (2) stepped care in case of anxiety disorder and/or depression, and (3) exercise therapy in case of impaired functional mobility. The primary outcome measure is dizziness-related impairment, which will be assessed with the Dizziness Handicap Inventory. Secondary outcome measures are quality of life, anxiety disorder and depression, use of fall-risk-increasing drugs, dizziness frequency, fall frequency, and healthcare utilization. Discussion: This study is, to date, the first study that will investigate the effectiveness of a prognosis-oriented approach for reducing dizziness-related impairment in older people in primary care. Offering treatment that addresses identified modifiable risk factors to patients at high risk for chronic dizziness is unique. The pragmatic design of this study will enable evaluation of the outcomes in real-life routine practice conditions. An effective intervention will not only reduce dizziness-related impairment, but may also decrease healthcare utilization and healthcare costs

[Rational prescription of antidepressants for depression]

Antidepressants are the subject of lively public debate. Over one million Dutch people are prescribed an antidepressant each year for a variety of reasons. The number of long-term antidepressant users is smaller, estimated to be around 150,000 patients for over a year for depression. Clinicians and patients together must carefully weigh the pros and cons of antidepressants. In this article, we discuss the latest scientific insights how antidepressants can be used rationally