Drop attacks in older adults: systematic assessment has a high diagnostic yield

J Am Geriatr Soc. 2005 Jan;53(1):74-8. doi: 10.1111/j.1532-5415.2005.53013.x.


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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Aged
  • Emergency Service, Hospital
  • Female
  • Follow-Up Studies
  • Health Services / statistics & numerical data*
  • Humans
  • Male
  • Morbidity
  • Physical Examination
  • Risk Factors
  • Syncope / diagnosis*
  • Syncope / etiology*
  • United Kingdom