Falls, non-accidental falls and syncope in community-dwelling adults aged 50 years and older: Implications for cardiovascular assessment

Bhangu, Jaspreet; King‐Kallimanis, Bellinda L.; Donoghue, Orna A.; Carroll, Laura M.; Kenny, Rose Anne

doi:10.1371/journal.pone.0180997

Cited by 31 publications

(31 citation statements)

References 34 publications

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“…In the multivariate analysis, antianginals and opioids were significantly associated with falls. These findings were similar to the study by de Jong et al and may be due to sudden hypotension, arrhythmia or a syncopal episode . There was also a significant difference in fear of falls and vision impairment between the groups.…”

Section: Discussionsupporting

confidence: 90%

Prevalence and predictors of falls in a health‐seeking older population: An outpatient‐based study

et al. 2020

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Background Falls are one of the major causes of disability in older people. A wide range of risk factors for falls are described according to setting – inpatient, nursing homes and community. The aim of this study was to identify the risk factors for falls in an outpatient setting. Methods In this cross‐sectional observational study, 160 consenting subjects were enrolled randomly, from the Geriatric Medicine outpatient department, All India Institute of Medical Sciences, New Delhi, India. Non‐ambulatory, seriously ill subjects were excluded. The subjects underwent brief evaluation including falls and geriatric assessment. They were grouped into fallers and non‐fallers. A multivariable logistic regression analysis was used to identify the factors associated with falls. Results The prevalence of falls was 23.75% (38/160). Women were proportionately higher (26.31%) in the fallers group vis‐à‐vis 19.67% in the non‐fallers group. After multivariate analysis, opioids (odds ratio [OR] 5.24 [95% CI, 2.0 18‐13.611]), vision impairment (OR 2.71 [95% CI, 1.050‐07.011]), fear of falling (OR 3.17 [95% CI, 1.167‐08.629]), instrumental activity of daily living (IADL) impairment (OR 3.41 [95% CI, 1.251‐09.301]), anti‐anginal medications (OR 8.90 [95% CI, 0.997‐79.564]) and self‐employment (OR 5.37 [95% CI, 1.058‐27.329]) were associated with falls. Adequate nutrition (OR 0.82 [95% CI, 0.688‐00.976]) and caregiver support (OR 0.46 [95% CI, 0.275‐00.801]) were protective of falls. Conclusion We identified the multi‐factorial etiology of falls. Patients having any of the above risk factors should undergo detailed fall risk assessment and preventive measures afterwards.

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Section: Discussionsupporting

confidence: 90%

Prevalence and predictors of falls in a health‐seeking older population: An outpatient‐based study

et al. 2020

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“…The sample in this study reported more falls (34.10 %) than what was previously reported in older adults with CVD 2,31 . In the Cardiovascular Health study, 13.2% of older adults with CVD related risk factors reported falling 31 .…”

Section: Discussioncontrasting

confidence: 53%

“…One out of four older adults falls each year, accounting for more than fifty billion dollars in health care costs 1 . Adults with cardiovascular disease (CVD) are reported to have higher odds of falling as compared to those without reported CVD 2 . A link between cognition and falls/falls risk has been reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

“…Studies in CVD which address falls risk factors have primarily focused either on mobility related factors such as decreased gait speed, impaired balance or the presence of disease associated side effects (e.g. orthostatic hypotension) 2,21 . Although changes in functional mobility provide sufficient evidence of the concern of falls in CVD, a crucial knowledge gap exists in the additional role that cognitive impairment plays on falls, given the prevalence of cognitive decline in older adults with CVD.…”

Section: Introductionmentioning

confidence: 99%

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Beyond balance and mobility, contributions of cognitive function to falls in older adults with cardiovascular disease

Blackwood

Gore

2019

JFSF

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Objectives: Older adults with cardiovascular disease (CVD) are at risk for cognitive impairment. Cognitive function is associated with falls in older adults however it is unknown if a relationship exists between cognitive function and falls in CVD. The aim of this study was to examine the contributions of cognitive function on falls in older adults with CVD. Methods: A secondary analysis was performed on data from the Health and Retirement Study cohort 2010 (N=3413) of older adults with CVD. Group assignment was based on falls history (yes/no) within the two years prior to the survey. Demographic (age, education, gender, marital status), physical (strength, balance, physical activity, and mobility) and cognitive (immediate and delayed recall, orientation, semantic verbal fluency, numeracy) information was extracted to characterize the sample. Comparisons between groups were completed for all of these variables. Logistic regression was performed to examine associations between each of the cognitive variables and falls while controlling for age, gender, marital status, education, and BMI. Results: Demographic (age, gender, marital status, and education), physical (grip strength, tandem stance time, and gait speed), and cognitive (orientation, immediate and delayed recall) variables differed by falls history (p<0.05). After controlling for confounding, immediate recall was the only significant predictor of falls (OR=1.09, 95% CI=1.01-1.17) (Nagelkerke R 2 =0.037, χ 2 =35.14, p<0.05) with correctly classifying 65.9% of cases. Conclusions: In older adults with CVD, cognitive and physical functions are more impaired in those with a falls history. Screening for cognitive function, specifically immediate recall, should be a part of the management of falls in this population.

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“…Particularly, hip fractures are major consequences of syncope-related falls and are associated with approximately 25% reduction of life expectancy and institutionalisation rates ranging between 8% and 34% in community-dwelling patients 26. Differentiation between falls and syncope is challenging, especially among elderly patients with cognitive impairment and experience from dedicated syncope and fall facilities reinforces the evidence of an overlap between these two entities, which are often indistinguishable and likely manifestation of the similar underlying pathophysiology 27. Both non-accidental falls and syncope show strong association with antihypertensive treatment and number of prevalent cardiovascular conditions including atrial fibrillation 27.…”

Section: Discussionmentioning

confidence: 95%

Pacing therapy in the management of unexplained syncope: a tertiary care centre prospective study

et al. 2019

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ObjectivePacemaker (PM) therapy is effective when syncope is associated with bradycardia, but syncope recurrences and fall injuries after PM implantation may occur. We aimed to survey indications and outcomes of PM implantation, following evaluation of unexplained syncope.MethodsAmong 1666 consecutive unpaced patients investigated in a tertiary syncope unit by carotid-sinus massage (CSM), head-up tilt test (HUT) and ECG monitoring, 106 (6.4%; age, 65 ± 17 years) received a PM. We assessed bradycardia detection methods, PM implantation indications, and explored incidence of recurrent syncope, fall-related fractures and mortality.ResultsIndications for PM therapy were met in 32/106 patients (30%) by CSM, in 41/106 (39%) by HUT, in 14/106 patients (13%) by implantable loop-recorder (ILR) and in 19/106 (18%) by standard ECG. Sinus arrest with asystole was the predominant PM indication during CSM/HUT and external ECG monitoring, whereas ILR detected proportionally the same numbers o f asystole due to sinus arrest and atrioventricular block. During follow-up (median, 4.3 years), 15 patients (14%) had syncope recurrence, 15 suffered fall-related fractures and 9 died. Neither syncope recurrence nor fall-related fractures were dependent on initial PM indication. The composite endpoint of recurrent syncope/fall-related fracture was associated with treated hypertension (OR 2.45; 95% CI 1.00 to 6.0), reduced glomerular filtration rate (OR 1.63 per 10 mL/min↓; 95% CI 1.22 to 2.19) and atrial fibrillation (OR 3.98; 95% CI 1.11 to 14.3). Recurrent syncope predicted increased mortality (OR 9.20; 95% CI 1.89 to 44.8).ConclusionsCardiovascular autonomic testing and ECG monitoring effectively identify pacing indications in patients with unexplained syncope. After PM implantation, treated hypertension, renal failure and atrial fibrillation predict syncope recurrence and fall-related injury. Recurrent syncope predicts increased mortality.

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Falls, non-accidental falls and syncope in community-dwelling adults aged 50 years and older: Implications for cardiovascular assessment

Cited by 31 publications

References 34 publications

Prevalence and predictors of falls in a health‐seeking older population: An outpatient‐based study

Prevalence and predictors of falls in a health‐seeking older population: An outpatient‐based study

Beyond balance and mobility, contributions of cognitive function to falls in older adults with cardiovascular disease

Pacing therapy in the management of unexplained syncope: a tertiary care centre prospective study

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