Psychological factors associated with chronic dizziness in patients aged 60 and older.

Objective: To identify the prevalence and character of psychological disorders accompanying chronic dizziness in older patients.

Design: Case series of patients from a geriatric dizziness clinic, with comparison data from age- and sex-matched healthy community controls. Both cases and controls received screening psychological testing; all cases were evaluated by a clinical psychologist as part of the dizziness clinic evaluation.

Setting: Multidisciplinary Geriatric Dizziness Clinic.

Participants: Fifty six consecutive patients with chronic dizziness, evaluated by a multidisciplinary Geriatric Dizziness Clinic, and 68 healthy volunteers whose age and sex distribution matched that of the dizziness clinic patients.

Measurements: Standardized questionnaire for medical, functional, and demographic data; the anxiety, depression, somatization, and phobic anxiety subscales of the Symptom/Checklist-90 (SCL-90-R); the Tinetti gait and motor screen; a physical therapy evaluation; selected laboratory tests; evaluation by a geriatrician; and a formal evaluation by a clinical psychologist, including a semistructured interview. Psychological diagnoses were assigned based on DSM-III-R criteria.

Main Results: Of these patients with chronic dizziness, 37.5 percent had a psychological diagnosis causing or contributing to their dizziness problem. Of these, only 3 were felt to have a primary psychological cause of their dizziness, and 18 had secondary psychological diagnoses. Anxiety disorders, depression, and adjustment reactions were the most common diagnoses. On multivariate analysis, factors predicting a psychological diagnosis were a positive response to hyperventilation testing, a high score on the SCL-90 anxiety subscale, and fatigue as a precipitant of dizziness. In addition, dizziness clinic patients scored significantly higher (P < 0.001) on all 4 subscales of the SCL-90 when compared with the healthy elderly, suggesting a greater degree of psychological distress among these elderly with chronic dizziness.

Conclusions: Psychological disorders are rare as primary causes but are common as contributing or modulating factors in older persons with dizziness.