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Heart disease, not inner ear problems, appears to be the most common cause of dizziness in elderly patients seen in primary care offices, Dutch researchers say.

In a cross-sectional analysis, cardiovascular disease was the most common cause of dizziness, occurring in 57% of patients, Otto R. Maarsingh, MD, of VU University Medical Center in the Netherlands, and colleagues reported in the May/June Annals of Family Medicine.

Vestibular disease appeared to be the cause in only 14% of patients, the researchers found.

Dizziness is a diagnostic challenge because it depends on self-report and can have many causes, the researchers said. Yet 30% of patients over age 65 experience some form of the condition and seek care from their doctors.

However, only a few diagnostic studies on dizziness have been done among patients in a family care setting.

To describe subtypes and assess causes, the researchers conducted a cross-sectional study among elderly patients in the Netherlands who saw their family physician for persistent dizziness.

All 417 patients ages 65 to 95 were seen by 45 family physicians in 24 Dutch family practices between June 2006 and January 2008. Each had a comprehensive examination.

The researchers found that presyncope was the most common subtype of dizziness at 69%, followed by vertigo at 41%, disequilibrium at 40%, and "other dizziness" at 2%.

The researchers noted that 44% of patients had more than one dizziness subtype.

When it came to causes, the researchers found that cardiovascular disease was the most common major contributory cause, occurring in 57% of patients.

It was followed by peripheral vestibular disease (14%) and psychiatric illness (10%).

Among minor contributory causes, adverse drug effects appeared to be the most common at 23% -- a prevalence much higher than reported in previous studies, the researchers said.

"It is possible, however, that previous investigators may have underestimated the contribution of drugs as a cause of dizziness in elderly patients, because they only registered a small selection of all potentially dizziness-causing drugs," they wrote.

Overall, 62% of patients had more than one contributory cause of dizziness.

Many studies have attributed dizziness to vestibular causes, but the researchers said their findings may be different because of a younger patient population or differences in patient setting.

"Family physicians should anticipate that many dizzy elderly patients have more than one cause of dizziness," they concluded. Such an approach may, "if not solve the problem of dizziness, lead to a clinically relevant reduction of impairments that contribute to dizziness."

They study was limited by a lack of clinical follow-up and relatively low levels of inter-rater agreement, which suggests discordant disease classification, the researchers said.

It was also limited by a discrepancy between the results of physical examination, additional diagnostic tests, and the final distribution of contributing causes of dizziness.

For example, the authors noted, even though there was a low frequency of abnormal findings during cardiovascular testing, the panelists considered cardiovascular disease to be the most common cause of dizziness.

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