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      Falls, non-accidental falls and syncope in community-dwelling adults aged 50 years and older: Implications for cardiovascular assessment

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          Abstract

          Objectives

          To calculate the prevalence of all falls, non-accidental falls and syncope in an older population and characterize cardiovascular risk profiles.

          Design

          Prospective, longitudinal cohort study.

          Setting

          The first two waves of data from the Irish Longitudinal Study on Ageing (TILDA).

          Participants

          8172 community-dwelling adults aged 50 years and older resident in the Republic of Ireland

          Measurements

          Self-reported history of all falls, non-accidental falls and syncope in the year preceding the first two waves of data collection. Demographic factors and self-reported cardiovascular conditions were used to characterize cardiovascular risk profiles.

          Results

          The prevalence of all falls in the past year was 19.2% or 192 per thousand persons and increased with age (50–64 years 17.5%; 65–74 years 19.4%; 75+ years 24.4%). Non-accidental falls had an estimated prevalence of 5.1% or 51 falls per thousand persons and accounted for 26.5% of all falls reported and also increased with age (50–64 years 4.0%; 65–74 years 5.5%; 75+ years 8.0%). The prevalence for syncope was estimated to be 4.4% or 44per thousand persons but did not show a similar age gradient. Participants with at least 5 cardiovascular conditions were more likely to report all falls (OR = 2.07, 95% CI 1.18–3.64, p<0.05) and NAF (OR = 2.89, 95%CI 1.28–6.52, p<0.05).

          Conclusions

          The prevalence of all falls and non-accidental falls increases with age but the same pattern was not consistently observed for syncope. There is an increased odds of reporting all three outcomes with increasing number of self-reported cardiovascular conditions. Further work is needed to uncover the interplay between cardiovascular disease and subsequent falls.

          Related collections

          Most cited references28

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          Risk factors for falls among elderly persons living in the community.

          To study risk factors for falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and gait; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P less than 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elderly persons who are at the greatest risk of falling.
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            Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons.

            (2011)
            The following article is a summary of the American Geriatrics Society/British Geriatrics Society Clinical Practice Guideline for Prevention of Falls in Older Persons (2010). This article provides additional discussion of the guideline process and the differences between the current guideline and the 2001 version and includes the guidelines' recommendations, algorithm, and acknowledgments. The complete guideline is published on the American Geriatrics Society's Web site (http://www.americangeriatrics.org/health_care_professionals/clinical_practice/clinical_guidelines_recommendations/2010/). © 2011, Copyright the Authors. Journal compilation © 2011, The American Geriatrics Society.
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              Guidelines for the diagnosis and management of syncope (version 2009).

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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: ResourcesRole: SoftwareRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                21 July 2017
                2017
                : 12
                : 7
                : e0180997
                Affiliations
                [001]The Irish Longitudinal Study on Ageing, Trinity College, Dublin, Ireland
                Cardiff University, UNITED KINGDOM
                Author notes

                Competing Interests: The authors have declared that no competing interests exist.

                Author information
                http://orcid.org/0000-0003-3934-2967
                Article
                PONE-D-17-08371
                10.1371/journal.pone.0180997
                5521793
                28732008
                70c34318-81d0-4a75-b6c0-22ac59a4c627
                © 2017 Bhangu et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 4 March 2017
                : 23 June 2017
                Page count
                Figures: 1, Tables: 4, Pages: 12
                Funding
                Funding for TILDA was gratefully received from the Atlantic Philanthropies ( www.atlanticphilanthropies.org), the Irish Government, and the Health Research Board ( www.hrb.ie). TILDA was funded by the Department of Health and Atlantic Philanthropies, along with support from Irish Life in the form of a charitable gift. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
                Research Article
                Medicine and Health Sciences
                Diagnostic Medicine
                Signs and Symptoms
                Syncope
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Signs and Symptoms
                Syncope
                Medicine and Health Sciences
                Public and Occupational Health
                Traumatic Injury Risk Factors
                Falls
                Medicine and Health Sciences
                Neurology
                Cerebrovascular Diseases
                Stroke
                Ischemic Stroke
                Medicine and Health Sciences
                Vascular Medicine
                Stroke
                Ischemic Stroke
                Medicine and Health Sciences
                Cardiology
                Arrhythmia
                Medicine and Health Sciences
                Cardiology
                People and Places
                Demography
                Medicine and Health Sciences
                Cardiovascular Medicine
                Cardiovascular Diseases
                Medicine and Health Sciences
                Vascular Medicine
                Angina
                Custom metadata
                The anonymised TILDA dataset is publicly available to researchers who meet the criteria for access, at no monetary cost, from the Irish Social Science Data Archive (ISSDA) at University College Dublin ( http://www.ucd.ie/issda/data/tilda/) and the Interuniversity Consortium for Political and Social Research (ICPSR) at the University of Michigan ( http://www.icpsr.umich.edu/icpsrweb/ICPSR/studies/34315). TILDA also considers applications for privileged access to the dataset through an onsite “hot desk” facility based in TILDA (visit www.tilda.ie for further information).

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                Uncategorized

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