title: Drop attacks in older adults: systematic assessment has a high diagnostic yield.
abstract: OBJECTIVE
  To investigate the causes of recurrent drop attacks in older patients with a comprehensive battery of investigations in the largest series reported to date.
  
  
  METHODS
  Observational with mean followup of 18 months.
  
  
  METHODS
  Inner city emergency department and tertiary facility in Newcastle upon Tyne, United Kingdom.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Falls 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>
authors.forename: Steve W
authors.initials: SW
authors.lastname: Parry
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Kenny
mesh_terms: D000367:Age Factors; D000368:Aged; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009017:Morbidity; D010808:Physical Examination; D012307:Risk Factors; D013575:Syncope / Q000175:diagnosis* / Q000209:etiology*; D006113:United Kingdom