Treating dizziness in older people
Prof Stephen Lord, Dr Jasmine Menant, A/Professor Americo Migliaccio, Prof Jacqueline Close, Prof Nick Titov, Dr Daina Sturnieks, Associate Professor Kim Delbaere
Between 10-30% of older community-living population report dizziness often leading to functional disability and psychological distress. The multifactorial aetiology of dizziness combined with a lack of validated diagnostic tests, and a tendency of clinicians to rely on poorly described symptoms and familiar assessments, are significant barriers to objectively establishing a successful diagnosis and implementing effective interventions. Thus, despite effective treatments being available, up to 40% of older people with reported dizziness remain undiagnosed and untreated. A multidisciplinary assessment battery, with new validated assessments of vestibular impairments is required for diagnosing and treating older people with dizziness. This project will therefore aim to conduct a randomised-control trial of a multifaceted dizziness intervention based on a multidisciplinary assessment, and develop a multiple profile assessment of dizziness for use in Specialist Clinics. The sample will comprise 300 people aged 70+ years. Baseline assessments will include self-report items and tests of vestibular, cardiovascular, neuromuscular, balance and psychological functioning. Interventions will be targeting the key underlying causes of dizziness and will be based on the highest level of evidence for each subtype and condition and include: vestibular rehabilitation, medication management, cognitive-behavioural therapy and exercise program. The primary outcome measures will be assessed at baseline and 6-month retest and will capture the four crucial aspects of the trial: reported dizziness, choice-stepping reaction time test (a composite balance measure), gait variability and quality of life. We anticipate that our project will produce a validated assessment tool for providing a differential diagnosis of dizziness and solid evidence that the burden of dizziness in older people can be effectively treated.