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Pain and Anxiety Mediate the Relationship Between Dizziness and Falls in Older People
Author(s) -
Menant Jasmine C.,
Wong Alfred,
Sturnieks Daina L.,
Close Jacqueline C.T.,
Delbaere Kim,
Sachdev Perminder S.,
Brodaty Henry,
Lord Stephen R.
Publication year - 2013
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/jgs.12131
Subject(s) - medicine , anxiety , vertigo , physical therapy , posturography , neck pain , depression (economics) , prospective cohort study , balance (ability) , tinnitus , audiology , surgery , psychiatry , alternative medicine , pathology , economics , macroeconomics
Objectives To identify medical, psychological, and physiological mediators of the relationship between dizziness and falls in older adults. Design Secondary analysis of a prospective cohort study. Setting Community. Participants Five hundred sixteen community‐dwelling adults aged 73 to 92. Measurements Participants completed questionnaires related to health and psychological well‐being and underwent a tilt table blood pressure test, the Physiological Profile Assessment (PPA; vision, reaction time, proprioception, postural sway, and quadriceps strength), and leaning balance tests. Prospective falls data were collected using monthly calendars for 12 months. Participants were categorized into dizzy and nondizzy groups based on self‐report of dizziness, vertigo, and light‐headedness. Results Two hundred seventeen (42%) participants reported vertigo or dizziness (10%), light‐headedness (16%), or both (16%). The dizzy participants were significantly more likely to report neck and back pain, past transient ischemic attacks, and feeling dizzy upon upright tilting. They also had poorer balance and less strength and scored higher on measures of depression and anxiety ( P < .05). There were no blood pressure measurement–related differences between the groups. Dizziness increased the risk of multiple falls in an unadjusted analysis (relative risk (RR) = 1.55, 95% confidence interval = 1.08–2.23). After controlling for PPA scores, neck and back pain and anxiety were mediators that reduced the RR of the relationship between dizziness and faller status the most (14%) in a modified Poisson regression model. Conclusion Suffering from neck and back pain and anxiety were mediators of the relationship between dizziness and falls after controlling for poor sensorimotor function and balance. Older people with dizziness might benefit from interventions targeting these mediators such as pain management and cognitive behavioral therapy.