Russell Roberts1, Corinne Jeffrey, Gary Carlisle, Elizabeth Brierley. 1. Department of Renal Medicine, Bradford Teaching Hospitals NHS Trust, St Luke's Hospital, Little Horton Lane, Bradford BD5 0NA, UK. russell.roberts@bradfordhospitals.nhs.uk
Abstract
BACKGROUND: Prevention of falls in the elderly is a major health care target. There are theoretical reasons why older dialysis patients may be at high risk of falls: co-morbidity, medication, and post-dialysis hypotension, which have not been well tested. Dialysis patients are also at higher risk of fracture if they do fall. METHODS: We prospectively interviewed all our centre haemodialysis patients over a 6 month period to see if they reported falls, syncope, pre-syncope or dizziness. Routine blood pressure (BP) and other clinical data were recorded. RESULTS: A total of 78 patients completed the study. There was a high incidence of all four symptoms but only falls was age-related. About 38% of patients aged >65 reported 1 or more fall compared to 4% of younger patients (p < 0.001). There were no significant differences in pre-dialysis, post-dialysis or standing BP between young and older patients or between fallers and non-fallers although the older patients did have a greater magnitude in change between pre-dialysis BP and post-dialysis standing BP. CONCLUSIONS: Older haemodialysis patients have a high incidence of falls. Falls can be prevented by addressing modifiable risk factors. Whether existing guidelines are applicable to this specialised population is uncertain. There is a high incidence of syncope in dialysis patients of all ages and the cause of this needs further exploration.
BACKGROUND: Prevention of falls in the elderly is a major health care target. There are theoretical reasons why older dialysis patients may be at high risk of falls: co-morbidity, medication, and post-dialysis hypotension, which have not been well tested. Dialysis patients are also at higher risk of fracture if they do fall. METHODS: We prospectively interviewed all our centre haemodialysis patients over a 6 month period to see if they reported falls, syncope, pre-syncope or dizziness. Routine blood pressure (BP) and other clinical data were recorded. RESULTS: A total of 78 patients completed the study. There was a high incidence of all four symptoms but only falls was age-related. About 38% of patients aged >65 reported 1 or more fall compared to 4% of younger patients (p < 0.001). There were no significant differences in pre-dialysis, post-dialysis or standing BP between young and older patients or between fallers and non-fallers although the older patients did have a greater magnitude in change between pre-dialysis BP and post-dialysis standing BP. CONCLUSIONS: Older haemodialysis patients have a high incidence of falls. Falls can be prevented by addressing modifiable risk factors. Whether existing guidelines are applicable to this specialised population is uncertain. There is a high incidence of syncope in dialysis patients of all ages and the cause of this needs further exploration.
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