Blunted baroreflex sensitivity: An underestimated cause of falls in the elderly?

Abstract

BackgroundAutonomic nervous system disturbance and cardiovascular disorders may be underestimated causes of falls. Heart rate turbulence (HRT), heart rate variability (HRV) and QT dynamicity parameters are noninvasive cardiac autonomic activity markers. The aim of this study was to evaluate autonomic cardiovascular markers in falling older adults. MethodsThis was a case-control study conducted at a geriatric medicine outpatient clinic of a university hospital. Study group consisted of 33 older adults who had falls in the last 12months and the control group included 31 subjects who had never experienced falls. The patients in the study group were examined with 24-hour Holter electrocardiogram (ECG) and carotid sinus massage was done under monitorization. The 24-hour Holter ECG data were recorded and assessed with the ELATEC software. HRV, QT dynamicity and HRT parameters were analysed. ResultsThirty-three faller and 31 non-faller patients were examined in this study. Age and gender were similar between groups. All patients and control subjects had normal ejection fraction. Carotid sinus massage was done to the patients in the study group and three of 33 were positive (9.09%). There was no significant difference in HRV and QT dynamicity parameters between groups. Both HRT onset (2.51±1.48 vs. 7.29±3.28 P<0.001) and turbulence slope (0.15±1.10 vs. −0.73±1.89; P=0.031) were significantly different between the groups. ConclusionElderly subjects with recent falls have significantly worse HRT parameters than matched non-falling counterparts. Blunted baroreflex sensitivity and impaired cardiac autonomic function can be an important reason for falls in the geriatric age group.