Clinical differences among the elderly admitted to the emergency department  for accidental or unexplained falls and syncope

Pasqualetti, Giuseppe; Calsolaro, Valeria; Bini, G; Dell’Agnello, Umberto; Tuccori, Marco; Marino, Angela; Capogrosso-Sansone, Alice; Rafanelli, Martina; Santini, Massimo; Orsitto, E; Ungar, Andrea; Blandizzi, Corrado; Monzani, Fabio

doi:10.2147/cia.s127824

Cited by 3 publications

(2 citation statements)

References 44 publications

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“…For example, unrecognized dementia is associated with diagnostic inaccuracy as clinicians evaluate a patient's acute complaints and the cause of their symptoms . Dementia is also associated with increased use of the ED, prolonged ED length of stay, increased admission rates, prolonged hospitalizations, incident delirium, fall risk, and higher mortality, as well as subsequent ED returns and hospital readmissions . Therefore, older adults with dementia represent a vulnerable ED population that will present with increasing frequency over coming decades.…”

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confidence: 99%

Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Carpenter

Banerjee

Keyes

et al. 2018

Academic Emergency Medicine

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ED-based diagnostic research for dementia screening is limited to a few studies using an inadequate criterion standard with variable masking of interpreter's access to the index test and the criterion standard. Standardizing the geriatric ED cognitive assessment methods, measures, and nomenclature is necessary to reduce uncertainties about diagnostic accuracy, reliability, and relevance in this acute care setting. The AMT-4 is currently the most accurate ED screening instrument to increase the probability of dementia and the Brief Alzheimer's Screen is the most accurate to decrease the probability of dementia. Dementia screening as one marker of vulnerability to initiate comprehensive geriatric assessment is warranted based on test-treatment threshold calculations.

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confidence: 99%

Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Carpenter

Banerjee

Keyes

et al. 2018

Academic Emergency Medicine

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“…Despite these limitations, our findings have potential clinical implications. Dementia and cognitive impairment are common chronic conditions affecting older individuals and, in these patients, falls and suspected syncope are frequent cause of admission to hospital [43][44][45]. Most of these vulnerable patients usually are treated with one or more psychoactive medications and other concomitant drug therapy potentially associated with QTc prolonging effect [30,46].…”

Section: Discussionmentioning

confidence: 99%

Prevalence, predictors and clinical implications of prolonged corrected QT in elderly patients with dementia and suspected syncope

Bo¹,

Ceccofiglio

Mussi

et al. 2019

European Journal of Internal Medicine

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Background: Long QT and use of QT-prolonging drugs are common among older patients receiving polytherapies, but real-world evidence on their impact in clinical practice is controversial. We investigated prevalence, variables associated and clinical implications of prolonged corrected QT (QTc) among patients from the Syncope and Dementia study. Methods: Observational, prospective, multicenter study. Patients≥65 years with dementia and fall suspected for syncope in the previous three months were enrolled. Several clinical variables and the complete list of medications were recorded for each patient. A 12-lead ECG was obtained and corrected QT was calculated by the Bazett's formula. One-year followup for death and recurrent syncope was performed. Results: Prolonged QTc was observed in 25% of the 432 enrolled patients (mean age 83.3), and was significantly associated with male gender (OR 2.09; 95% CI 1.34-3.26) and diuretics use (OR 1.85; 95% CI 1.18-2.90). At one-year 23.3% of patients died and 30.4% reported at least one recurrent event. Variables associated with oneyear mortality were: age, male gender, atrial fibrillation (AF), use of calcium channel blockers and prolonged QTc (OR 1.80; 95% CI 1.01-3.20). Among patients with prolonged QTc a significant interaction for mortality was found with AF. Recurrent events were associated with the use of antiplatelets, cholinesterase. inhibitors and antipsychotics, but not with prolonged QTc. Conclusions: We documented a high prevalence of prolonged QTc, that was associated with male gender and diuretics but not with psychoactive medications. Patients with prolonged QTc had higher one-year mortality, that was four-fold increased in those with concomitant AF. 1. Introduction Long QT syndrome is an electro-physiologic disorder in which the ventricular repolarization is lengthened, with an increased susceptibility to ventricular tachy-arrhythmias, potentially leading to syncope, cardiac arrest and sudden cardiac death [1]. Acquired prolonged QT interval is the most common form of long QT syndrome, and usually results from the complex interplay between several factors

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Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study

Clemens,

Iglseder,

Alzner

et al. 2024

Age and Ageing

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Background comprehensive medication management (CMM) can reduce medication-related risks of falling. However, knowledge about inter-individual treatment effects and patient-related barriers remains scarce. Objective to gain in-depth insights into how geriatric patients who have fallen view their medication-related risks of falling and to identify effects and barriers of a CMM in preventing falls. Design complementary mixed-methods pre–post study, based on an embedded quasi-experimental model. Setting geriatric fracture centre. Methods qualitative, semi-structured interviews framed the CMM intervention, including a follow-up period of 12 weeks. Interviews explored themes of falling, medication-related risks, post-discharge acceptability and sustainability of interventions using qualitative content analysis. Optimisation of pharmacotherapy was assessed via changes in the weighted and summated Medication Appropriateness Index (MAI) score, number of fall-risk-increasing drugs (FRID) and potentially inappropriate medications (PIM) according to the Fit fOR The Aged and PRISCUS lists using parametric testing. Results thirty community-dwelling patients aged ≥65 years, taking ≥5 drugs and admitted after an injurious fall were recruited. The MAI was significantly reduced, but number of FRID and PIM remained largely unchanged. Many patients were open to medication reduction/discontinuation, but expressed fear when it came to their personal medication. Psychosocial issues and pain increased the number of indications. Safe alternatives for FRID were frequently not available. Psychosocial burden of living alone, fear, lack of supportive care and insomnia increased after discharge. Conclusion as patients’ individual attitudes towards trauma and medication were not predictable, an individual and longitudinal CMM is required. A standardised approach is not helpful in this population.

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Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope

Cited by 3 publications

References 44 publications

Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Accuracy of Dementia Screening Instruments in Emergency Medicine: A Diagnostic Meta‐analysis

Prevalence, predictors and clinical implications of prolonged corrected QT in elderly patients with dementia and suspected syncope

Effects of medication management in geriatric patients who have fallen: results of the EMMA mixed-methods study

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