Drop attacks in older adults: systematic assessment has a high diagnostic yield
Open accessAbstract
OBJECTIVES: To investigate the causes of recurrent drop attacks in older patients with a comprehensive battery of investigations in the largest series reported to date. DESIGN: Observational with mean followup of 18 months. SETTING: Inner city emergency department and tertiary facility in Newcastle upon Tyne, United Kingdom. PARTICIPANTS: Ninety-three consecutive patients aged 55 and older with three or more drop attacks in the 6 months before evaluation. METHODS: Subjects underwent a comprehensive diagnostic evaluation, with particular attention to traditional (e.g., gait and balance abnormalities, medications) and more recently identified (e.g., carotid sinus hypersensitivity) risk factors for drop attacks. RESULTS: Subjects tended to be older (mean age+/-standard deviation 77.4+/-9.0) and female (70; 75%) and to have a mean of 10.4 drop attacks before evaluation. Fifty-three (57%) had suffered soft tissue injuries needing medical attention and 32 (34%) fractures secondary to drop attacks. An attributable diagnosis was achieved in all but nine subjects (90%). Cardiovascular diagnoses (49; 53%) were most commonly implicated, with neurological (27; 29%) and gait and balance abnormalities (17; 18%) and drug-related causes (11; 12%) providing the majority of the remaining diagnoses. CONCLUSION: Drop attacks in older subjects are associated with high levels of morbidity and healthcare resource utilization. Attributable diagnoses are achievable in the majority of cases with a systematic investigative approach. The high diagnostic yield more than justifies the approach described.
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Syncopal events may be unwitnessed in over half of older patients, meaning that collateral histories may not be available, which makes discrimination between falls and syncope challenging.
“Syncopal events may be unwitnessed in over half of older patients meaning that collateral histories may not available, which makes discrimination between falls and syncope challenging. 387”
From 2018 ESC Guidelines for the diagnosis and management of syncope (2018) · cites this paper as [387]
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- Authors
- Parry, S. W., & Kenny, R. A.
- Affiliations
- Royal Victoria Infirmary (GB)
- Venue
- Journal of the American Geriatrics Society
- Publisher
- Wiley
- Published
- 2004-12-22
- Volume
- 53
- Issue
- 1
- Pages
- 74-78
- ISSN
- 0002-8614 (ISSN-L)
- 1532-5415
- OpenAlex
- W1577700234
- Cited by
- 59
- References
- 24
- Citations by year
- 2026: 1 · 2025: 2 · 2023: 2 · 2022: 2 · 2021: 3 · 2018: 5 · 2017: 2 · 2016: 2 · 2015: 3 · 2014: 2 · 2013: 4 · 2012: 3
- FWCI
- 5.95
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Locations
- Journal of the American Geriatrics Society (publishedVersion)
- PubMed (publishedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- British Heart Foundation
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- drop attacks, falls in older adults, recurrent falls, diagnostic yield, carotid sinus hypersensitivity, drug-induced falls, fracture, soft tissue injury, healthcare resource utilization
- MeSH terms
- Age Factors, Aged, Emergency Service, Hospital, Female, Follow-Up Studies, United Kingdom, Health Services, Humans, Male, Morbidity, Physical Examination, Risk Factors, Syncope
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