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Hypocapnia and its relation to fear of falling
J E Clague1, P J Petrie, M A Horan
1Geriatric Medicine, Clinical Division 1, University of Manchester, UK.
Objective:
To determine if hypocapnia occurs in patients with fear of falling and to explore potential causes of hypocapnia.
Design:
Observational study in patients who fall with and without fear of falling.
Setting:
Rehabilitation wards of an elderly care unit.
Patients:
Consecutive fallers with (n = 20) and without (n = 10) fear of falling.
Main Outcome Measures:
End-tidal CO2 (PETCO2) and respiratory rate (RR) responses were measured during sustained isometric muscle contraction (SIMC) (40% of maximum voluntary contraction of quadriceps for 2 min) and during a 5-meter walk. Falls efficacy scale (FES) and Hospital anxiety and depression scale (HAD).
Results:
Patients with fear of falling had significantly higher FES and HAD scores (p < .01). During SIMC, baseline and nadir PETCO2 levels were significantly lower in patients with a fear of falling (p < .01). During the 5-meter walk, PETCO2 was lower at baseline, at nadir, and at the end of the walk in the fear of falling group than in controls (p < .01). RR was higher at nadir and end of the walk in the fear of falling group than in controls (p < .02).
Conclusions:
Hypocapnia may occur in patients with a fear of falling during SIMC and walking. Anxiety seems to be the main cause, but muscle weakness may contribute. Breathing or relaxation techniques and reconditioning may have a role in treating fear of falling in the rehabilitation setting.