Fall Risk Research Articles

A threshold model to determine the association between race rides and fall risk for early career (apprentice) jockeys

ObjectivesTo identify descriptors associated with success in apprentice jockeys and to determine optimum numbers of jockeys for safer race riding. DesignRetrospective cohort study. MethodsIncidence rates for jockey falls and success (wins per 1000 race starts), time and the number of races spent at different apprentice levels were calculated for 807 apprentice and professional jockeys over 19 years of Thoroughbred flat racing in New Zealand (n = 524,551 race starts). Survival analysis was used to compare career progression for jockeys that fell and those that did not, and individual seasonal fall incidence rates were modelled. ResultsApprentice jockeys had the highest fall incidence rate in their first year of race riding (2.4 interquartile range 1.7–3.2 vs 1.1 interquartile range 1.0–1.2, p < 0.05) and a lower success incidence rate compared to professional (non-apprentice) jockeys (71, interquartile range 67–75 vs 97 interquartile range 96–98, p < 0.05). Jockeys who fell during their apprenticeship rode in more race rides to progress towards professional status than those who did not. There was an inverse power relationship between fall incidence rates and the number of race rides per season for jockeys, with the inflexion point at 33 rides per season. Half (48 %) of the jockeys rode fewer than 33 rides per season. ConclusionsThere is a surplus number of jockeys, riding at high fall risk, produced than is required by the number of race riding opportunities. Greater investment into the fitness, education and selection of a smaller cohort of dedicated apprentices may be beneficial to reduce the risk of early career fall or injury in jockeys and requires further investigation.

Ecological and health risk assessment of heavy metals in interior dust from college campus.

Contamination of college campus dust with heavy metals and the calculation of their ecological and health risks to the students and staff did not receive much attention except in recent years. This study aims to assess the ecological and human health risks of Cd, Cr, Cu, Pb, and Zn in interior dust of College of Science/University campus. An atomic absorption spectrophotometer was utilized to estimate the samples that were collected from 46 locations of the college campus including: classrooms, offices, and laboratories. The Pb, Cu, Cr and Zn metals in the interior dust of the College of Science pose low potential ecological risk, whereas Cd generates medium potential ecological risk. The gained results showed that the student and staff of the College are exposed to low non-cancerous health risks (HI < 1) caused by Cd, Cr, Cu, Pb, and Zn in interior dust. The total lifetime carcinogenic risks (TLCR) of Cd, Cr, and Pb are within the acceptable safe limit (10-6-10-4). The low non-carcinogenic health risks of Cd, Cr, Cu, Pb, and Zn and that the carcinogenic health risks of Cd, Cr and Pb fall within acceptable safe limits, measured in the interior dust of the campus of the College of Science, does not mean neglecting the continuous assessment of those risks.

Two simple modifications to the World Falls Guidelines algorithm improves its ability to stratify older people into low, intermediate and high fall risk groups.

We conducted a secondary analysis of a cohort study to examine the World Falls Guidelines algorithm's ability to stratify older people into sizable fall risk groups or whether minor modifications were necessary to achieve this. Six hundred and ninety-three community-living people aged 70-90years (52.4% women) were stratified into low, intermediate and high fall risk groups using the original algorithm and a modified algorithm applying broader Timed Up and Go test screening with a >10-s cut point (originally >15s). Prospective fall rates and physical and neuropsychological performance among the three groups were compared. The original algorithm was not able to identify three sizable groups, i.e. only five participants (0.7%) were classified as intermediate risk. The modified algorithm classified 349 participants (50.3%) as low risk, 127 participants (18.3%) as intermediate risk and 217 participants (31.3%) as high risk. The sizable intermediate-risk group had physical and neuropsychological characteristics similar to the high-risk group, but a fall rate similar to the low-risk group. The high-risk group had a significantly higher rate of falls than both the low- [incidence rate ratio (IRR) = 2.52, 95% confidence interval (CI) = 1.99-3.20] and intermediate-risk groups (IRR = 2.19, 95% CI = 1.58-3.03). A modified algorithm stratified older people into three sizable fall risk groups including an intermediate group who may be at risk of transitioning to high fall rates in the medium to long term. These simple modifications may assist in better triaging older people to appropriate and tailored fall prevention interventions.

Transhumeral prosthesis use and disuse affects whole-body angular momentum

BackgroundIndividuals with transhumeral limb loss have an increased risk of falling, potentially resulting from altered upper-body kinematics during gait. The purpose of this study was to investigate whole-body angular momentum as a measure of movement control, to gain an understanding of how these upper-body kinematics contribute to dynamic balance. MethodsEight participants with transhumeral limb loss and eight able-bodied control participants completed three gait trials at self-selected speeds. The participants with transhumeral limb loss performed trials with and without their prosthesis. Coefficient of cancellation and whole-body angular momentum about all anatomical axes of rotation were calculated. Means and variance were compared across the conditions over the gait cycle via statistical parametric mapping, and ranges were compared using a one-way ANOVA. FindingsCoefficient of cancellation was decreased between the upper/lower extremities in the transverse plane and between the upper extremities/trunk in the sagittal plane for both transhumeral walking conditions compared to the control group. Whole-body angular momentum was statistically different in the sagittal plane and decreased in the transverse plane when walking with the prosthesis compared to the control group. Walking without the prosthesis resulted in increased variability of whole-body angular momentum. InterpretationIndividuals with transhumeral limb loss had dysregulated whole-body angular momentum compared to the control group. This dysregulation was related to decreased segment-to-segment cancellation from the upper extremities and increased variance throughout the gait cycle. Based on these findings, individuals should be encouraged to wear their transhumeral prosthesis while walking as it may reduce fall risk and fatigue.

Comparison of gnri, pni,conut with MNA-SF to assess prognostic value for fall risk in older adults

Comparison of gnri, pni,conut with MNA-SF to assess prognostic value for fall risk in older adults

Sensitivity of Fall Risk Perception and Associated Factors in Hospitalized Patients with Mental Disorders

PurposeTo reduce falls in hospitalized patients with mental disorders, the patients should be sensitive to fall risk perception. This study identified the sensitivity to fall risk perceptions and associated factors, including demographic, clinical, and fall-related factors, among inpatients with mental disorders. MethodsWe used a descriptive, cross-sectional design, recruiting 170 inpatients with mental disorders from two psychiatric hospitals in South Korea. Sensitivity to fall risk perception was classified using fall occurrence and the Fall Risk Perception Questionnaire. ResultsThe prevalence of falls was 16.5%. Approximately 47% of falls occurred within 10 days of hospitalization, 67.9% within 1 month, and 85.7% within 2 months. Among the 28 participants who fell, 60.7% had inadequate-low sensitivity to fall risk perception. Among the 142 participants who did not fall, 11.3% had inadequate-high sensitivity to fall risk perception. Low sensitivity to fall risk perception was related to diagnosis, psychiatric symptoms, and fall history due to the mental disorder. High sensitivity to fall risk perception was related to age at onset of the mental disorder, urinary or bowel problems, and fear of falling. The multiple logistic regression found that the diagnosis and fall history due to the mental disorder were associated with inadequate-low sensitivity, and age at onset and fear of falling were associated with inadequate-high sensitivity to fall risk perception. ConclusionsOver 60% of patients who fell had low sensitivity to fall risk perception. Inadequate-low and high sensitivity to fall risk perception are related to the demographic, clinical, and fall-related characteristics among inpatients with mental disorders. Therefore, nurses should assess fall risk perception, consider these factors together during this assessment, and manage them appropriately in hospitalized patients with mental disorders.

Fall risk screening in older adults using the “CARE” frailty scale: The NuAge cohort results

Background“CARE” is an electronic health (e-health) application (app) which assesses frailty with its frailty module and risk of falls with its mobility module. This study examines and compares the risk of incident falls (i.e., ≥1, ≥2 and severe falls) among older people in Quebec classified as “frail” and those classified as being at a high risk of falls by the CARE app. MethodsA subset of men and women (n = 1151; 74.2 ± 4.2 years; 52.8 % female) who participated in the Quebec Longitudinal Study on Nutrition and Successful Aging (NuAge) were selected for this study. Pre-frail and frail states using the CARE frailty scale as well as high risk of falls estimated by CARE mobility module were determined at baseline. Pre-frail and frail states were merged in a single “frail state” group. Incident falls (i.e., ≥1, ≥2 and severe falls) were annually recorded over a 3-year follow-up. ResultsBoth CARE frail state (Odd ratio (OR) ≥1.89 with P ≥ 0.040) and high risk of falls estimated by the CARE mobility module (OR) ≥3.32 with P ≥ 0.023) were significantly associated with incident falls (i.e., at least one fall) and recurrent falls (i.e., at least two falls). A greater association with these fall outcomes was observed with the high risk of falls than with the frail state. No significant association between the high risk of falls and severe falls was found (OR = 1.71 with P = 0.227), whereas that was the case with frail state (OR = 3.08 with P = 0.003). ConclusionsFrail state determined by the CARE frailty module and high risk of falls determined by the CARE mobility module were both significantly associated with fall outcomes, a greater association being shown with the CARE high risk of falls and with CARE frail state for severe falls. These results suggest that the CARE app may be useful for screening older people for the risk of falls.

The effects of subsensory electrical noise stimulation on the reactive control of balance during support surface perturbations

BackgroundThe ability to respond effectively to balance perturbations is crucial for fall prevention. Subsensory electrical stimulation (SES) applied to the skin leads to improved proactive balance control but there is limited evidence on the SES effect on reactive balance control. Research QuestionsTo test the efficiency of SES in improving reactive balance control against unpredictable support surface perturbations and to compare the effects of SES applied to the trunk and the lower legs. MethodsTwenty-three young adults stood on a treadmill while recovering from 15 forward and 15 backward surface translations of increasing magnitude to determine the backward and forward stepping thresholds (BSTh and FSTh). Then, they recovered from three repetitions of forward and backward perturbations of fixed magnitude to determine the characteristic of the compensatory step (i.e., step time, step length, step delay and Margin of Stability - MOS). Each test was conducted with no stimulation (NS), leg stimulation (LS), or trunk stimulation (TS) equal to 90% of the sensory threshold. Repeated-measures ANOVA and Tukey post-hoc tests were used to analyze the main and interaction effects of stimulation and repetition. ResultsTS and LS increased the BSTh by 31.5% (p=0.002) and 16.4% (p=0.028), respectively, with greater effects of TS; (ii) during backward perturbations, TS reduced compensatory step time by 9.0%, step length by 17.1%, and MOS at compensatory heel strike by 17.7% (p<0.016); and (iii) during forward perturbations, LS and TS reduced the step time by 4.5% and 3.5% (p<0.017), and increased the minimum MOS by 7.8% and 4.5%, respectively (p<0.048). SignificanceThis is the first study that showed how the application of SES affects reactive balance control during support surface perturbations. TS was more effective than LS during backward perturbations. TS may be an effective strategy to enhance balance control during reactive postural tasks, thus potentially reducing fall risk.

Prognostic factors of falls in hospitalized adults and elderly: An epidemiological and clinical analysis

BackgroundFalls are known to cause injuries ranging from minor to severe, resulting in local or systemic lesions. Addressing prognostic factors associated with falls is crucial for preventing this adverse event through the implementation of patient care protocols. This study aimed to explore the epidemiological, clinical, and pharmacological prognostic factors influencing falls in adult and elderly patients, assessing the timing and impact of these factors using survival curve analysis. MethodsA retrospective observational cohort study included 176 hospitalized patients experiencing falls, categorized into adults (<60 years) and elderly (≥60 years). Binomial tests and logistic regression assessed variable associations, while Kaplan-Meier curves and Cox proportional hazards models analyzed survival. ResultsOverall, 25.9 % of adults and 33.3 % of the elderly experienced some form of injury (minor or moderate). Patients were alone during the fall in 77.6 % of cases for those under 60, compared to 50 % for those 60 and older (p < 0.001). Falls from own height were the most common, occurring in 46.6 % of patients under 60 years and 66.7 % of elderly patients (p = 0.011). Among adults under 60, factors such as past alcohol history (p = 0.0276), falling alone (p = 0.0002), benzodiazepine use (p = 0.0001), antiarrhythmic/antihypertensive medication (p = 0.0005), and antipsychotics (p = 0.0001) were significantly associated with falls. In the elderly, significant factors included falling from one's own height (p = 0.0112), muscle weakness (p = 0.0183), gait disorders (p = 0.0443), vasodilators (p = 0.0107), antihistamines (p = 0.0003), and hypoglycemic agents (p = 0.0041). Survival curve analysis indicated women under 60 had a worse prognosis for falls compared to elderly women (p = 0.038). For the elderly, opioid use (p = 0.045) and muscle weakness (p = 0.037) represented poor prognostic factors compared to adults under 60. In Cox regression, only female sex in patients under 60 showed a higher risk (HR=1.47) compared to women over 60 (p = 0.0014). Although not significant in multivariate analysis, muscle weakness (p = 0.066) and opioid use (p = 0.0545) had proportional hazards of 1.37 and 1.12, respectively. ConclusionFemale sex indicated poorer prognosis in <60 s, while opioids and muscle weakness were concerning for the elderly. These findings emphasize the need for tailored care protocols to stratify patient fall risk and prognosis during hospitalization and develop effective preventive strategies in healthcare.

Computerized Posturography With Machine Learning To Individualize Balance Training And Mitigate Fall Risk In Cardiac Rehabilitation

Computerized Posturography With Machine Learning To Individualize Balance Training And Mitigate Fall Risk In Cardiac Rehabilitation

Evaluation of Nutrition, Pressure Ulcer and Fall Risk Status and Related Factors in Individuals Receiving Home Health Care Services

Objective: In this study, the aim is to evaluate the factors associated with nutrition, pressure ulcers, and fall risks in individuals receiving home health care. Methods: A retrospective study was designed by examining the files of the patients registered in the Home Health Care. Mini Nutritional Assessment Short Form, Modified Norton Scale and Itaki Fall Risk Scale scores were recorded. Results: The study included 334 patients. 197 (59%) of them were female and the mean age was 74.15±16.12 (min: 18, max: 101). The most common chronic diseases was hypertension (HT) (n=167, 50%), whereas the two most common comorbidities were DM and HT (n=77,23.1%). Patients receiving home health care were found to be at risk for malnutrition, pressure ulcers and falls. Being semi-bedridden and wheelchair bound were found to be predictors for the risk of developing pressure ulcers according to regression analysis results. Also it was identified that the age and dependency levels of the patients receiving home health care explained 12% of the falling behaviours of the older people. Conclusion: Necessary warnings should be given at every visit, so that receiving home health care should not be neglected in terms of risks and preventive measures should be taken for this patient group.

Using the Nintendo™ Wii to Improve Physical Function and Reduce the Risk of Falls in Older Adults: A Randomized Controlled Clinical Trial.

(1) Background: Numerous exercise programs that improve physical capacity and the risk of falls in older adults have been proposed with varying degrees of success. A novel approach may be to use a video game system that uses real-time force feedback to train older adults. The aim of this study was to evaluate the effects of a Nintendo™ Wii-based exercise program on physical function and risk of falls in older people. (2) Methods: This 12-week randomized controlled clinical trial involved 73 participants: 36 individuals participating in a control group (CG) and 37 in an experimental group (EG) participating in a combined program. Balance was measured using the Tinetti scale, flexibility was assessed with the back scratch test and the sit-and-reach test, and lower body strength was assessed with the 30 s chair stand-up test. (3) Results: The results of this study show significant improvements in balance, gait, flexibility, and strength of the lower limbs compared to a control group. (4) Conclusions: A Nintendo™ Wii-based exercise program for seniors produces improvements in the physical health of older adults. These improvements highlight the importance of integrating physical exercise through video games as an effective strategy to improve the general health and quality of life of older adults.

Effect of Cognitive Control and Dual-Task Training on Gait Stability and Fall Risk In Older Adults: A Cross-Sectional Study

Effect of Cognitive Control and Dual-Task Training on Gait Stability and Fall Risk In Older Adults: A Cross-Sectional Study

Optimizing Underground Coal Mine Safety: Leveraging Advanced Computational Algorithms for Roof Fall Rate Prediction and Risk Mitigation

AbstractThe utilization and consumption of coal in various nations have emphasized the pivotal role played by coal mines. However, aside from the substantial contribution of coal mines, miners, engineers, and craftsmen in this industry have long been exposed to numerous risks and financial losses resulting from roof collapses in underground coal mines. Hence, due to the heightened sensitivity surrounding this issue, the accurate and low-error forecasting and assessment of the roof fall rate (RFR) are deemed crucial and of utmost importance. Nonetheless, due to the intricate and uncertain inherent characteristics of the rock formations, assessing the RFR has encountered multiple challenges that cannot be precisely approximated through traditional methods. In this paper, algorithms such as the harmony search algorithm (HS) and the invasive weed Optimization algorithm (IWO) are harnessed to address the aforementioned challenges. To model the RFR, a total of 109 data points were used, incorporating input parameters such as primary roof support (PRSUP), depth of cover (D), coal mine roof rating (CMRR), mine height (MH), and intersection diagonal span (IS). For effective data analysis and model development, the dataset was split into two separate groups: one for training and the other for testing. Specifically, 80% of the data was used to build the model, while the remaining 20% was allocated for model evaluation and validation. Based on the outcomes of three statistical metrics R2, MSE, and RMSE, it is evident that the deployment of HS and IWO algorithms demonstrates high performance, with predicted values closely aligning with actual ones. Consequently, the utilization of intelligent algorithms in the field of rock engineering is positioned as a potent tool for researchers and engineers. In conclusion, a sensitivity analysis is carried out with the help of the @RISK software as a means of ranking the influence that the input parameters have on the output of the model. Its results indicate that among different parameters, the CMRR parameter with a sensitivity degree of 0.11 has the most impact on the model, even with the smallest change in this parameter, a significant change is made in the model output.

Low-intensity blood flow restriction (LI-BFR) and moderate-intensity improves quadriceps strength and thigh circumference in older women

Background and objectives. Weakness and atrophy in the quadriceps femoris lead to decreased functional capacity, heightened fall risk, and increased mortality among older women. While moderate-intensity strength training is generally recommended for the elderly, higher-intensity exercises carry a greater risk of injury. Low-intensity exercises with blood flow restriction offer an alternative, providing comparable benefits to high-intensity training. This study aims to evaluate the effects of moderate-intensity and low-intensity blood flow restriction exercises on quadriceps femoris strength and thigh circumference in healthy elderly women. Materials and methods. The sample size was of 88 subjects equally randomized into a moderate-intensity group and a blood-flow restriction group. The moderate-intensity group performed strengthening exercises with a load of ≥40–60% of 1RM, 3 sets, 36 repetitions. The blood-flow restriction group conducted exercises at 20–30% of 1RM, completing 75 repetitions across 4 sets, using a pressure cuff applied to the upper thigh at 50 mmHg or 40% of the Arterial Occlusion Pressure (AOP). Both groups exercised twice a week over a 6-week period. Muscle strength (assessed via dynamometer and 1RM) and thigh circumference were recorded before and after the intervention. Results. After six weeks of intervention, both groups showed a significant increase in muscle strength and thigh circumference (p &lt;0.001). However, no notable differences were observed between the moderate intensity group and the blood flow restriction group regarding quadriceps strength (dynamometer), quadriceps 1RM strength, or thigh circumference (p &gt;0.05). Muscle soreness was reported in 18% of participants in the moderate intensity group. Conclusion. Low-intensity resistance exercises with blood flow restriction in older women can promote strength gains and muscle hypertrophy comparable to moderate-intensity training, while offering a safer alternative.

Exergames and Immersive Virtual Reality as a Novel Therapy Approach in Multiple Sclerosis: Randomised Feasibility Study

Background: Multiple sclerosis is a chronic, inflammatory, neurodegenerative autoimmune disease caused by myelin loss in the central nervous system, which leads to motor and non-motor problems. The main objective of this study was to explore whether an immersive virtual reality (IVR) exercise programme would be feasible as a form of physical therapy for people with MS (pwMS). Methods: 18 participants (13 women; 45.06 years) were assigned to an experimental group (EG, n = 8) and a control group (CG, n = 10). The EG took part in a twice-weekly IVR exergame physical therapy programme—ExeRVIEM programme. A randomised, single-blind clinical trial was conducted and was registered in clinicaltrials (NCT05870254). Results: The intervention was feasible and safe. The participants completed the programme with no adverse effects (no symptoms on the Simulator Sickness Questionnaire), high usability (System Usability Scale 90.31%), and outstandingly positive post-game experiences (Game Experience Questionnaire 3.10/4). In addition, the GE significantly improved several of their functional capacities: increased lower limb strength (Five Times Sit-to-Stand Test p = 0.042), improved functional mobility, and reduced fall risk (Timed Up and Go Test-simple p = 0.009; Timed Up and Go Test-cognitive p = 0.003). There were no statistically significant differences between the groups. Conclusions: The findings support that the use of exergames and IVR as physical therapy in pwMS is feasible and safe. Furthermore, there is the suggestion of possible benefits to participants’ functional abilities, all of which position IVR as a promising tool for the rehabilitation of this neurodegenerative pathology affecting young adults.

Identification and Modification of Fall-Risk-Increasing-Drugs Following Fall-Related Hospitalization in Older Adults

Abstract Background Falls are a common cause of hospitalization in older adults and carry a significant risk of morbidity and mortality. Polypharmacy and certain medications are strongly associated with increased falls risk. Guidelines recommend that falls requiring hospitalization should trigger a multi-factorial risk assessment, including medication review. This study aims to describe the prevalence of fall-risk-increasing-drugs (FRIDs) in older adults admitted with a fall, and to determine whether or not these medications are appropriately identified, reviewed and modified as per the hospital’s recently developed ‘Guideline on Medication and the Risk of Falls’. Methods Hospital admissions were screened daily to identify fallers. Medical chart and drug kardex review was performed to collect demographic data and FRIDs prescription. Anticholinergic burden was calculated using the ACB score. Documentation of medicine reconciliation, indication for FRIDs, and modification of FRIDs by the admitting team was recorded. Results Data was prospectively collected on 25 consecutive patients, 18 (72%) were female and the average age was 82. Overall, 23 (92%) of were prescribed FRIDs and 21 (84%) had polypharmacy. Average ACB score was 1.76 (range 0-6). The most commonly prescribed FRIDs were anti-hypertensives (72%), diuretics (48%) and anti-depressants (44%). FRIDs were identified as a potential cause of falls in six (24%) cases, and their indication was documented in four (16%) cases. FRIDS were reduced, stopped or changed to a safer alternative in eight (32%) of cases. Conclusion FRIDs are commonly prescribed for older adults, with an average of three FRIDS prescribed per patient in this study. The need for improvement in recognition and documentation of FRIDs as potential contributors to falls has also been highlighted. Further education and dissemination of the ‘Guideline on Medication and the Risk of Falls’ is prudent to ensure proper prescribing and de-prescribing practices.

Antipsychotic Prescribing and Falls Risk in Nursing Home Residents with Dementia

Abstract Background Falls are a common syndrome in older adults leading to adverse outcomes including functional decline, activity restriction, injury and death. They can still occur in residential care. We examined prescribing of medications included in STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk) (1) in nursing home residents with dementia. Methods A point prevalence audit was conducted in a dementia-specific nursing home. Data were collected from the electronic healthcare record on demographics, dementia severity, and number of falls in the preceding 12 months. The number and class of regular medications were recorded. Non-cognitive symptoms of dementia were quantified using the Cohen Mansfield Agitation Inventory (CMAI). Results Seventy-four residents were included with mean age 82 years, 59(70%) female. The average Mini Mental State Examination (MMSE) was 5/30 and 80% had severe dementia. The average CMAI score was 50. The mean number of falls was 3 (range 0-14). Regular prescribing of specific STOPPFall medications was as follows: antipsychotics 42/74 (57%), benzodiazepines 8/74 (11%), opioids 13/74 (18%), antidepressants 44/74 (59%), antiepileptics 11.74 (15%), diuretics 12/74 (16%). Prescription of a regular antipsychotic was associated with one or more falls (OR 3.19, p = 0.029). There was no significant difference in falls with the other medications studied. The number of falls increased with higher agitation scores. Conclusion Antipsychotics increased the risk of falls in a nursing home setting. Fallers had higher rates of agitation, perhaps explaining the increased usage of antipsychotics. Medications should be reviewed on a regular basis and deprescribing considered where appropriate. Reference 1. Seppala LJ, Petrovic M, Ryg J, Bahat G, Topinkova E, Szczerbińska K, et al. STOPPFall (Screening Tool of Older Persons Prescriptions in older adults with high fall risk): a Delphi study by the EuGMS Task and Finish Group on Fall-Risk-Increasing Drgs. Age and Ageing. 2020;50(4):1189-99.

The Effect of Fludrocortisone on Ambulatory Blood Pressure Markers of Falls Risk Amongst Older People with Falls

Abstract Background Fludrocortisone is frequently used to raise blood pressure in older patients with falls due to hypotension, yet evidence to support its use is limited. The aim of this study was to assess changes in Ambulatory Blood Pressure Monitors (ABPM) markers of future falls risk seen after commencing/increasing Fludrocortisone in older people with falls due to orthostatic hypotension (OH) or vasovagal syncope. Methods A cohort of older patients (≥65 years) attending a tertiary-referral falls &amp; syncope unit and prescribed Fludrocortisone were included. ABPM at index visit and follow-up (after commencing/increasing Fludrocortisone) were analysed, with specific focus on markers of future falls risk: overall Systolic Blood Pressure (sBP), minimum sBP, sBP variability &amp; ‘dips’ in systolic sBP &amp;lt;100 mm Hg. These variables were compared pre and post Fludrocortisone using paired t-tests. Results Twenty-three patients (median age 74 years (SD 6.05), 3/4 with OH) were followed for median 4.5 (SD 6.53) months. Two-thirds were commenced on Fludrocortisone, with the dose increased in the rest. Patients commencing Fludrocortisone had a significant increase in overall sBP from 110.13mmHg (95% CI 104.26 – 116.00) to 127.93mmHg (95% CI 120.00 – 135.87) (p&amp;lt;0.001) at follow-up, and a significant increase in minimum sBP from 82.2mmHg (95% CI 76.25 – 88.15) to 99.87mmHg (95% CI 91.47 – 108.26) (p=0.001). There was also a significant reduction in the number of SBP ‘dips’ after commencing Fludrocortisone (9.6 pre to 2.67 post, (95% CI 0.08 – 5.25), p=0.004)), and after commencing/increasing Fludrocortisone dose (8.09 pre to 2.74 post (95% CI 0.62 – 4.85) (p=0.012)). Conclusion This study provides clinical data on the effectiveness of Fludrocortisone in older patients with falls due to hypotension, demonstrating significantly improved markers of future falls risk. Overall sBP increased significantly by 16% and minimum sBP increased by over 20% after starting Fludrocortisone. The number of SBP ‘dips’ also significantly reduced, by over 70% in those who commenced Fludrocortisone.

Cerebral Hypoperfusion And Future Falls Risk Among Community Dwelling Older Adults with Orthostatic Hypotension

Abstract Background Falls occur in approximately 33% of those over 65 annually, with 10-20% resulting in injury or hospitalisation. Orthostatic Hypotension (OH) characterised by significant blood pressure (BP) drops upon standing is frequently identified in those with unexplained falls (UF). Cerebral hypoperfusion is regarded as the mechanism by which OH contributes to falls risk. However, work looking at the direct interaction between OH, cerebral perfusion and falls is lacking. Methods Near Infrared Spectroscopy (NIRS) derived frontal lobe cerebral oxygenation (reported as tissue saturation index (TSI)) and continuous beat-to-beat BP by finometer were measured in parallel during active standing among participants aged ≥55 at wave3 of TILDA (n=2478). OH, was defined as persisting systolic BP drop ≥20mmHg and/or diastolic BP drop ≥10mmHg at 30, 60 and 90seconds post standing. TSI drop from baseline ≥75th centile at 30seconds informed the “greater TSI drop” variable for longitudinal analysis. Multilevel linear regression models assessed the association between change in TSI from baseline and OH. Multilevel logistic regression models assessed the longitudinal relationship between OH, cerebral perfusion and future UF at 4years follow up (waves 4-5). Results Twenty percent had OH and were more likely to be older and have cardiovascular disease. TSI drops from baseline after standing were significantly greater in those with OH at 30 (beta=0.32 [CI 0.15-0.49]; p&amp;lt;0.001), 60 (beta=0.41 [CI 0.23-0.6]; p&amp;lt;0.001), and 90 (beta=0.46 [CI 0.27-0.65]; p&amp;lt;0.001) seconds in fully adjusted models. After robust adjustment, combination of OH with greater TSI drops was strongly associated with future UF (Odds Ratio (OR) 2.23 [CI 1.35-3.69]; p=0.002), while OH and lower TSI drops were not (OR 1.27 [CI 0.87-1.85]; p=0.216). Conclusion These novel findings confirm that degree of cerebral hypoperfusion on standing informs risk of future UF in those with OH and has important clinical implications for the risk assessment of older people presenting with falls.