title: Can echocardiographic findings predict falls in older persons?
abstract: BACKGROUND
  The European and American guidelines state the need for echocardiography in patients with syncope. 50% of older adults with syncope present with a fall. Nonetheless, up to now no data have been published addressing echocardiographic abnormalities in older fallers.
  
  
  RESULTS
  In order to determine the association between echocardiographic abnormalities and falls in older adults, we performed a prospective cohort study, in which 215 new consecutive referrals (age 77.4, SD 6.0) of a geriatric outpatient clinic of a Dutch university hospital were included. During the previous year, 139 had experienced a fall. At baseline, all patients underwent routine two-dimensional and Doppler echocardiography. Falls were recorded during a three-month follow-up. Multivariate adjustment for confounders was performed with a Cox proportional hazards model. 55 patients (26%) fell at least once during follow-up. The adjusted hazard ratio of a fall during follow-up was 1.35 (95% CI, 1.08-1.71) for pulmonary hypertension, 1.66 (95% CI, 1.01 to 2.89) for mitral regurgitation, 2.41 (95% CI, 1.32 to 4.37) for tricuspid regurgitation and 1.76 (95% CI, 1.03 to 3.01) for pulmonary regurgitation. For aortic regurgitation the risk of a fall was also increased, but non-significantly (hazard ratio, 1.57 [95% CI, 0.85 to 2.92]). Trend analysis of the severity of the different regurgitations showed a significant relationship for mitral, tricuspid and pulmonary valve regurgitation and pulmonary hypertension.
  
  
  CONCLUSIONS
  Echo (Doppler) cardiography can be useful in order to identify risk indicators for falling. Presence of pulmonary hypertension or regurgitation of mitral, tricuspid or pulmonary valves was associated with a higher fall risk. Our study indicates that the diagnostic work-up for falls in older adults might be improved by adding an echo (Doppler) cardiogram in selected groups.
authors.affiliation: Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, Netherlands; Section of Geriatrics, Erasmus University Medical Center, Rotterdam, Netherlands; Department of Epidemiology & Biostatistics, Erasmus University Medical Center, Rotterdam, Netherlands.
authors.forename: Nathalie
authors.initials: N
authors.lastname: van der Velde
authors.forename: Bruno H Ch
authors.initials: BH
authors.lastname: Stricker
authors.forename: Jos R T C
authors.initials: JR
authors.lastname: Roelandt
authors.forename: Folkert J
authors.initials: FJ
authors.lastname: Ten Cate
authors.forename: Tischa J M
authors.initials: TJ
authors.lastname: van der Cammen
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000203:Activities of Daily Living; D000368:Aged; D001022:Aortic Valve Insufficiency / Q000453:epidemiology; D001794:Blood Pressure / Q000502:physiology; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology; D006801:Humans; D002546:Ischemic Attack, Transient / Q000453:epidemiology; D008297:Male; D008487:Medical History Taking; D008609:Mental Status Schedule; D008944:Mitral Valve Insufficiency / Q000453:epidemiology; D011187:Posture; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D013575:Syncope / Q000150:complications / Q000000981:diagnostic imaging / Q000453:epidemiology; D013599:Systole / Q000502:physiology