Occam's Razor, Geriatric Syndromes, and the Dizzy Patient
Authors: David A. Drachman
Journal: Annals of Internal Medicine (2000)

Editorials7 March 2000Occam's Razor, Geriatric Syndromes, and the Dizzy PatientDavid A. Drachman, MDDavid A. Drachman, MDUniversity of Massachusetts Medical School; Worcester, MA 01655 (Drachman)Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-132-5-200003070-00010 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In the 14th century, English philosopher William of Ockham (Occam) stated: Pluralitas non est ponenda sine necessitate, or "Plurality must not be posited without necessity" (1). In medicine, the application of "Occam's razor," the concept of parsimony in diagnosis, has become firmly entrenched as a fundamental principle. For persons older than 65 years of age, however—especially those who experience dizziness—Occam's razor is often too sharp and cuts too narrowly to be the instrument of choice (2). Senescence, the age-related changes that result in increased vulnerability to impairment and disease and in decreased survival (3), results in at least one chronic ...References1. Jefferys WH, Berger JO. Ockham's razor and Bayesian analysis. American Scientist. 1992;80:64-72. Google Scholar2. Irvine PW. Patterns of disease: the challenge of multiple illnesses. In: Cassell CK, Riesenberg DE, Sorensen LB, Walsh JR, eds. Geriatric Medicine. 2d ed. New York: Springer-Verlag; 1990:96-101. Google Scholar3. Masoro EJ. Aging: current concepts.. In: Masoro EJ, eds. Handbook of Physiology: Aging. v 11. New York: Oxford Univ Pr; 1995:3-24. Google Scholar4. Tinetti ME, Inouye SK, Gill TM, Doucette JT. Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes. JAMA. 1995;237:1348-53. CrossrefGoogle Scholar5. Drachman DA, Hart CW. An approach to the dizzy patient. Neurology. 1972;22:323-34. CrossrefMedlineGoogle Scholar6. Drachman D. Dizziness.. In: Feldmann E, eds. Current Diagnosis in Neurology. Philadelphia: Mosby-Year Book; 1994:264-70. Google Scholar7. Schöne H. Spatial Orientation. The Spatial Control of Behavior in Animals and Man. Strausfeld C, trans. Princeton: Princeton Univ Pr; 1984. Google Scholar8. Drachman D. A 69-year-old man with chronic dizziness. JAMA. 1998;280:2111-8. CrossrefMedlineGoogle Scholar9. Tinetti ME, Williams CS, Gill TM. Dizziness among older adults: a possible geriatric syndrome. Ann Intern Med. 2000;132:337-44. LinkGoogle Scholar10. Baloh RW. Dizziness in older people. J Am Geriatr Soc. 1992;40:713-21. CrossrefMedlineGoogle Scholar11. Belal A, Glorig A. Dysequilibrium of ageing (presbyastasis). J Laryngol Otol. 1986;100:1037-41. CrossrefMedlineGoogle Scholar12. Grimby A, Rosenhall U. Health-related quality of life and dizziness in old age. Gerontology. 1995;41:286-98. CrossrefMedlineGoogle Scholar13. Physicians' Desk Reference. Montvale, NJ: Medical Economics; 1995. Google Scholar14. Epley JM. Particle repositioning for benign paroxysmal positional vertigo. Otolaryngol Clin North Am. 1996;29:323-31. CrossrefMedlineGoogle Scholar15. Moore H. Sayings.. In: Alvarez J, Oldham P, Morphew L, eds. Old Age Ain't for Sissies. Cameron NC: Crane's Creek Pr; 1995. Google Scholar Author, Article, and Disclosure InformationAffiliations: University of Massachusetts Medical School; Worcester, MA 01655 (Drachman)Grant Support: In part by grant AG05134, the Sterling Morton Charitable Trust, and the Harriet and Stanley Friedman Research Fund.Corresponding Author: David A. Drachman, MD, Department of Neurology, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoDizziness among Older Adults: A Possible Geriatric Syndrome Mary E. Tinetti , Christianna S. Williams , and Thomas M. Gill Chronic Dizziness among Older Adults Michael I. Weintraub Chronic Dizziness in Older Adults Athanasios Katsarkas Some Considerations regarding Geriatric Syndromes Elizabeth A. Phelan , Elizabeth K. Vig , and Itamar B. Abrass William of Occam and Occam's Razor Vincent Lo Re III and Lisa M. 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Abrass, MDDizziness: State of the SciencePhilip D. Sloane, MD, MPH, Remy R. Coeytaux, MD, Rainer S. Beck, MD, and John Dallara, MDChronic Dizziness in Older AdultsAthanasios Katsarkas, MSc, MD, FRCSChronic Dizziness in Older AdultsJose S. Cheng, MDChronic Dizziness among Older AdultsMichael I. Weintraub, MD 7 March 2000Volume 132, Issue 5Page: 403-405KeywordsAgingArrhythmiaElderlyEtiologyGeriatricsHearingHypotensionPeripheral neuropathyVertigoWalking Issue Published: 7 March 2000 CopyrightCopyright © 2000 by American College of Physicians. All Rights Reserved.PDF DownloadLoading ...