An unexpected event in which the participant comes to rest on the ground, floor or lower level

Aetiology

• Prevalence increases with age
• Incidence is 3-fold higher in care home residents

Intrinsic factors contributing to falls

• Medical conditions
  • Diabetes mellitus → diabetic neuropathy → altered proprioception and poor vision
  • Arthritis, Parkinson’s, stroke → altered gait pattern
  • Incontinence → increased need to rush, mobilising at night etc.
  • Acute illness
• Cognition
• Impaired vision and hearing
• Age-related changes in gait, postural reflexes, muscle strength etc.

Extrinsic factors related to falls

• Medications - diuretics, anti-hypertensives, sedatives, anti-cholinergics, hypoglycaemic agents, psychotropic drugs
• Environmental - rugs, furniture, stairs etc.
• Inappropriate footwear
• Inappropriate use of walking aids
• Fear of falling → ‘cautious gait’ which actually decreases walking stability
  • Decrease walking speed and step length
  • Subsequent increased time that both feet are on the ground

Pathophysiology

Drop attack - carotid sinus syndrome

• Carotid sinus is an area of dilatation in the ICA which contains a number of baroreceptors
• In order to maintain homeostasis, as a response to increased pressure within the vessel wall the resultant effect is peripheral vasodilation and reduction in heart rate
• CSS is a condition of abnormal activation of this structure which leads to symptoms secondary to cerebral hypoperfusion