Premium
Drop Attacks in Older Adults: Systematic Assessment Has a High Diagnostic Yield
Author(s) -
Parry Steve W.,
Kenny Rose Anne
Publication year - 2005
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2005.53013.x
Subject(s) - medicine , medical diagnosis , observational study , foot drop , emergency medicine , pediatrics , surgery , pathology
Objectives: To investigate the causes of recurrent drop attacks in older patients with a comprehensive battery of investigations in the largest series reported to date. Design: Observational with mean followup of 18 months. Setting: Inner city emergency department and tertiary facility in Newcastle upon Tyne, United Kingdom. Participants: 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. Conclusion: 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.