Clinical differences among the elderly admitted to the emergency departmentfor accidental or unexplained falls and syncope

Clinical Interventions in Aging

关键词: older people;    frailty;    fall;    accidental fall;    syncope;   

DOI  :  

来源: DOAJ

【 摘 要 】

Giuseppe Pasqualetti,1 Valeria Calsolaro,1 Giacomo Bini,1 Umberto Dell’Agnello,1 Marco Tuccori,2 Alessandra Marino,2 Alice Capogrosso-Sansone,2 Martina Rafanelli,3 Massimo Santini,4 Eugenio Orsitto,4 Andrea Ungar,3 Corrado Blandizzi,2 Fabio Monzani1On behalf of the ANCESTRAL-ED study group1Geriatrics Unit, 2Pharmacology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, 3Syncope Unit, Geriatric and Intensive Care Medicine, AOU Careggi and University of Florence, Florence, 4Emergency Department, University Hospital of Pisa, Pisa, ItalyAbstract: It is difficult to distinguish unexplained falls (UFs) from accidental falls (AFs) or syncope in older people. This study was designed to compare patients referred to the emergency department (ED) for AFs, UFs or syncope. Data from a longitudinal study on adverse drug events diagnosed at the ED (ANCESTRAL-ED) in older people were analyzed in order to select cases of AF, syncope, or UF. A total of 724 patients (median age: 81.0 [65–105] years, 66.3% female) were consecutively admitted to the ED (403 AF, 210 syncope, and 111 UF). The number of psychotropic drugs was the only significant difference in patients with AF versus those with UF (odds ratio [OR] 1.44; 95% confidence interval 1.17–1.77). When comparing AF with syncope, female gender, musculoskeletal diseases, dementia, and systolic blood pressure >110 mmHg emerged as significantly associated with AF (OR 0.40 [0.27–0.58], 0.40 [0.24–0.68], 0.35 [0.14–0.82], and 0.31 [0.20–0.49], respectively), while valvulopathy and the number of antihypertensive drugs were significantly related to syncope (OR 2.51 [1.07–5.90] and 1.24 [1.07–1.44], respectively). Upon comparison of UF and syncope, the number of central nervous system drugs, female gender, musculoskeletal diseases, and SBP >110 mmHg were associated with UF (OR 0.65 [0.50–0.84], 0.52 [0.30–0.89], 0.40 [0.20–0.77], and 0.26 [0.13–0.55]), respectively. These results indicate specific differences, in terms of demographics, medical/pharmacological history, and vital signs, among older patients admitted to the ED for AF and syncope. UF was associated with higher use of psychotropic drugs than AF. Our findings could be helpful in supporting a proper diagnostic process when evaluating older patients after a fall.Keywords: older people, frailty, fall, accidental fall, syncope

【 授权许可】

Unknown