Effectiveness of Cardiovascular Evaluations and Interventions on Fall Risk: A Scoping Review

Abstract

Objective cardiovascular abnormalities are consistently associated with fall risk in older people. However, little research has been done to assess the effect of cardiovascular interventions on fall risk. The aim of this scoping review is to explore the current literature on the effectiveness of cardiovascular evaluations and interventions in reducing fall risk in older people. Design scoping review. Data sources Medline, Cochrane Library, and WHO ICTRP Search Portal were systematically searched. Selection criteria randomized controlled trials (RCTs) and intervention studies of community-dwelling adults aged ≥50 years or with a mean age of >60 years that assessed the effect of a cardiovascular assessment and interventions in reducing fall risk. Key search concepts were “falls” and “aged”, and terms for different cardiovascular evaluations and interventions were included. The Cochrane Checklist for risk of bias and the ROBINS-I tool were used to assess the quality of the studies. Results seven studies were included. The majority showed a reduction in falls after cardiovascular evaluation and intervention. Two out of four studies that focused on carotid sinus hypersensitivity (CSH) as a modifiable cardiovascular risk factor for falls, showed a significant reduction in falls after pacemaker implantation. Two studies that looked at sinus node dysfunction (SND) both showed a significant reduction in falls after pacemaker implantation. One study showed that 33% of the patients experienced a fall after cardiovascular evaluation and intervention, whereas all patients fell before assessment. Conclusions the majority of the included studies showed a reduction in falls after the intervention. However, the number of published papers regarding the effect of cardiovascular assessment and interventions on falls is small. A standardized assessment of cardiovascular risk factors may be essential in preventing falls in older adults and could consequently reduce injuries, loss of quality of life, deaths, and fall-related expenditures. Electronic Supplementary Material Supplementary material is available for this article at 10.1007/s12603-019-1165-2 and is accessible for authorized users.

Is orthostatic hypotension and co-existing supine and seated hypertension associated with future falls in community-dwelling older adults? Results from The Irish Longitudinal Study on Ageing (TILDA)

“…elastic stockings, abdominal binders) [ 35 ]. Currently, there are no clinical trials examining the effect of treatment of OH on falls, however the results of randomised clinical trials and cohort studies do suggest that cardiovascular evaluation and interventions may reduce falls in patient populations [ 36 ].…”

Link between cardiovascular disease and the risk of falling: A comprehensive review of the evidence

“…A 2018 Cochrane review concluded that although multifactorial interventions may reduce the rate of falls, there may be little or no difference in other fall-related outcomes [70], and a recent meta-analysis has called the usage of multifactorial interventions to decrease falls into question; the study found insufficient evidence and calls for further research for such patients over the age of 60 [99]. Although none of the multifactorial prevention strategies were primed exclusively to cardiovascular disorders, implementation and future research among patients suffering from such conditions would surely be feasible, especially in patients suffering from multiple comorbidities [100].…”

Impact of cardiovascular evaluations and interventions on fall risk in older adults: a protocol for a scoping review and evidence map

“…Falls are a leading cause of morbidity and mortality in older adults,5 and, therefore, identification of effective fall prevention interventions is crucial. In recent systematic reviews and (network) meta-analyses, Tricco et al and Dautzenberg et al 6 7 reported on the fall-reducing effects of various interventions, but a comprehensive overview solely focused on the fall risk reducing effects of cardiovascular assessments and treatments is currently lacking 8. The European Society of Cardiology guideline on syncope1 explicitly states that in case of unexplained falls, syncope is likely and therefore the same (cardiovascular) evaluation as for evident syncope is required.…”