Drop attacks in older adults: systematic assessment has a high diagnostic yield.
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.
Parry
Steve W
SW
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>
Kenny
Rose Anne
RA
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