Heart Problems May Be Cause of Some Seniors' FallsNovember 1, 2001 By Charnicia E. Huggins
NEW YORK (Reuters Health) - Unexplained falls among the elderly may not simply be due to aging. Rather, the falls may be a sign of an unrecognized heart problem, British researchers suggest.
Approximately one in three elderly people fall in their home each year, and one in six experiences a fall in a nursing home. Falls have been identified as the sixth leading cause of death among the elderly.
"Because these falls are unexplained, older people have a huge loss of confidence because they don't want it to happen again," lead study author Dr. Rose Anne M. Kenny, a cardiologist at the Institute for Aging and Health at the University of Newcastle in the UK, told Reuters Health.
"We need to have a system in which people who have unexplained, nonaccidental falls are aware that there might be a cardiac cause," she said. In particular, the researchers looked at cardioinhibitory carotid sinus hypersensitivity, a heart condition that causes fainting or blackouts and can be treated with a pacemaker.
Kenny's team studied 159 elderly individuals who had suffered falls and blackouts. This group was divided into a study group of 83 individuals who received a pacemaker to regulate their heart rate and a comparison group of 76 individuals who did not receive a pacemaker.
"This is the first time pacemakers have been studied for falls, not blackouts," Kenny said.
Overall, falls were reduced by 70% among individuals with the pacemaker, Kenny's team reports in the November issue of the Journal of the American College of Cardiology. Further, these individuals were not only less likely to fall than those in the comparison group but also reported fewer falls after receiving the pacemaker than they did previously.
Sixteen percent of the study participants said they experienced a total of 60 blackouts during the study period, the report indicates. Again, however, those with pacemakers were less likely to experience fainting after receiving the device than they were before receiving it.
Several explanations may exist for why the pacemakers seemed to make the elderly individuals less susceptible to falls, according to Kenny.
On one hand, the device can help regulate the heart rate of those who suffer blackouts and later amnesia about the blackout, she speculated. And on the other hand, it can regulate drops in heart rate that may be too small to cause a blackout but are large enough to cause a fall.
"Spouses, daughters or sons may have seen one of those (unexplained falls without blackouts)," Kenny said.
"People power" is needed to ensure that elderly individuals who suffer unexplained falls get to the right person--that is, the cardiologist--for assessment, the researcher added.
In a related editorial, Dr. John H. McAnulty of Oregon Health Sciences University, who is not associated with Kenny's research, writes that "the problem--falls--is so major, the diagnostic procedure so easy, the treatment so readily available and the study so good that it is tempting to proceed with pacemaker insertion."
Yet there are "soft aspects" of Kenny's study, he writes. For example, the study did not take into account disturbances in gait or medical conditions that may have been associated with the falls. The study also relied on self-reports from the seniors, and looks at a small group of individuals, he added.
In light of this, "the limitations are too great to comfortably apply this (pacemaker) approach to the huge number of elderly patients (experiencing unexplained) falls," McAnulty concludes.
SOURCE: Journal of the American College of Cardiology 2001;38:1491-1496.