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Drop attacks in older adults: systematic assessment has a high diagnostic yield
Steve W Parry1, Rose Anne Kenny
1Falls and Syncope Service and Institute for Aging and Health, Royal Victoria Infirmary, Newcastle upon Tyne, United Kingdom. steve.parry@nuth.northy.nhs.uk <steve.parry@nuth.northy.nhs.uk>
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.