92A CASE CONTROL STUDY OF CARDIOVASCULAR ASPECTS OF FALLS IN URBAN OLDER POPULATION IN MALAYSIA

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Abstract

Introduction: Fall is a ‘syndrome’ associated with a differential diagnosis or ‘a consequence’ from multiple synergistic factors. Cardiovascular risk factors such as orthostatic hypotension and carotid sinus hypersensitivity associated with falls.

Methods: This cross-sectional case-control study was conducted within 10-month. Cases participants aged ≥65 years old with > 2 falls or one injurious fall in the past within 12 months. Control participants were recruited from community dwelling older, similar hospital catchment area. Patients were evaluated with a multifactorial falls assessment including history taking, 12-lead ECG, lying and standing blood pressure (BP) continuous BP monitoring (Portapres®, FMS, Amsterdam).

Fallers randomized to intervention or control participants following the initial evaluation. The intervention group was referred for further cardiovascular evaluation. This included Holter monitoring, transthoracic echocardiography, carotid sinus massage and head-up tilt-table tests.

Results: Seventy-six cases and 50 control participants were recruited to the study. There were significant baseline differences in age and history of diabetes, cardiovascular diseases and hyperthyroidism between the two groups. There was a significant increase in systolic drop (mean (standard deviation, SD) = 35(21) vs 25 (19)mmHg, p = 0.032) and diastolic drop (15(13) vs 9(8)mmHg, p = 0.025). The diagnosis of orthostatic hypotension (OH) (odds ratio, OR (95% confidence interval, 2.68 CI= 1.00-7.19), p = 0.046 was significantly different between fallers and non-fallers. These differences remained statistically significant after adjustment for age and past medical illness of diabetes and cerebrovascular disease (systolic BP drop, p = 0.041; diastolic BP drop, p = 0.013; OH (adjusted OR (95%CI)= 5.42(1.55-18.93), p = 0.008). The PR interval was significantly prolonged (187(30) vs 160(32)msec, p = < 0.001) and bifascicular block was also more likely in fallers compared to non-fallers (9(12%)vs 0; p = 0.046).

Conclusions: Orthostatic hypotension is independent risk factor for falls. PR prolongation and bifascicular block associated with falls. Cardiac and blood pressure assessments are therefore important in the multifaceted assessment of falls.

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