Clinical differences among the elderly admitted to the emergency department for accidental or unexplained falls and syncope

Figures & data

Table 1 Patient characteristics (whole cohort and accidental falls, syncope, and unexplained fall subgroups) and logistic regression analysis

Clinical characteristics	Accidental falls (n=403)	Syncope (n=210)	Unexplained falls (n=111)	Total (N=724)	Accidental falls vs syncope (OR, 95% CI)	Accidental vs unexplained falls (OR, 95% CI)	Unexplained falls vs syncope (OR, 95% CI)
Median age (range), years	82.0 (65–105)a	81.0 (65–102)	81.50 (65–97)	81.0 (65–105)	0.97 (0.95–0.99)*	1.00 (0.97–1.02)	1.03 (0.99–1.06)
Gender (female)	73.20%a	50.48%c	71.17%	66.3%	0.37 (0.26–0.53)**	0.91 (0.57–1.45)	0.41 (0.25–0.68)**
Arterial hypertension	47.22%	48.44%	48%	47.7%	1.05 (0.74–1.49)	1.05 (0.67–1.63)	1.01 (0.62–1.65)
Depression	9.50%	11.54%	16.51%	11.2%	1.24 (0.72–2.13)	1.91 (1.04–3.51)*	0.66 (0.34–1.29)
Neurologic diseases	16.71%	19.14%	23.64%	18.5%	1.18 (0.77–1.82)	1.54 (0.92–2.58)	0.81 (0.46–1.42)
Dementia	8.46%	3.37%c	10.91%	7.4%	0.38 (0.16–0.87)*	1.35 (0.67–2.71)	0.30 (0.11–0.78)*
Cardiovascular disease	62%	57.21%	54.55%	59.5%	0.82 (0.58–1.15)	0.73 (0.48–1.12)	1.11 (0.69–1.77)
Arrhythmia	11.38%	12.22%	8.08%	11.1%	1.08 (0.63–1.88)	0.69 (0.31–1.53)	1.52 (0.64–3.59)
Hearth failure	4.43%	6.12%	8.49%	5.5%	1.41 (0.66–3.01)	1.97 (0.85–4.56)	0.68 (0.27–1.69)
Valvulopathy	0.26%a	2.55%	0.94%	1%	10.03(1.16–86.42)*	3.59 (0.22–57.89)	2.90 (0.33–25.16)
Coronary heart disease	10.42%	16.84%	16.98%	13.3%	1.74 (1.06–2.86)	1.78 (0.97–3.26)	0.98 (0.52–1.85)
Atrial fibrillation	12.16%	12.22%	13.27%	12.3%	1.01 (0.58–1.73)	1.08 (0.56–2.10)	0.92 (0.44–1.93)
Musculoskeletal disease	25.69%a	10.10%c	27.27%	21.4%	0.32 (0.20–0.54)**	1.06 (0.66–1.71)	0.32 (0.17–0.59)**
Anemia	2.80%	4.12%	1.96%	3.0%	1.49 (0.59–3.78)	0.75 (0.16–3.50)	2.27 (0.47–10.91)
Diabetes	18.75%	18.75%	22.73%	19.4%	1.00 (0.65–1.54)	1.27 (0.76–2.12)	0.78 (0.44–1.38)
Median value of CIRS-S (range)	1.23 (1.0–2.15)	1.23 (1–2.23)	1.23 (1–2.38)	1.23 (1–2.38)	2.22 (0.95–5.19)	1.44 (0.51–4.08)	1.39 (0.49–3.97)
Median value of CIRS-C (range)	1 (0–7)	1 (0–7)	1 (0–8)	1 (0–8)	1.16 (1.01–1.33)*	1.02 (0.86–1.21)	1.11 (0.92–1.33)
Median SBP mmHg (range)	135.50 (90–216)a	120 (65–220)c	140 (100–240)	130 (65–240)
Median DBP mmHg (range)	80 (50–120)a	70 (40–100)c	80 (40–120)	75 (40–120)
SBP >110 mmHg	89.30%a	69.60%c	90.60%	83.00%	0.29 (0.18–0.46)**	1.15 (0.53–2.51)	0.24 (0.11–0.50)**
Median number of drugs	4 (0–13)b	4 (0–18)	5 (0–15)	4 (0–18)	1.08 (1.02–1.15)*	1.12 (1.04–1.21)**	0.97 (0.90–1.04)
Drug interactions	51.96%	56.25%	57.28%	54.0%	1.19 (0.85–1.67)	1.25 (0.80–1.93)	0.95 (0.59–1.54)
Median number of antihypertensive drugs (range)	1 (0–5)a	1 (0–5)	1 (0–5)	1 (0–5)	1.30 (1.13–1.49)**	1.10 (0.92–1.32)	1.17 (0.97–1.42)
Median number of CNS drugs (range)	0 (0–4)b	0 (0–4)c	1 (0–4)	0 (0–4)	0.87 (0.71–1.06)	1.43 (1.16–1.75)**	0.64 (0.51–0.82)**
Median creatinine (mg/dL)d	0.88 (0.39–3.10)	1.01 (0.51–3.27)	0.89 (0.46–2.71)	0.91 (0.39–3.27)	1.9 (0.99–3.65)	2.01 (1.00–4.05)	0.53 (0.60–2.62)

Notes:

a Accidental falls vs syncope (P<0.05, Bonferroni corrected).

b Accidental falls vs unexplained falls (P<0.05, Bonferroni corrected).

c Syncope vs unexplained falls (P<0.05, Bonferroni corrected).

d Available only for 255 patients.

* P<0.05.

** P<0.01.

Abbreviations: CI, confidence interval; CIRS-C, Cumulative Illness Rating Scale Comorbidity; CIRS-S, Cumulative Illness Rating Scale Severity; CNS, central nervous system; DBP, diastolic blood pressure; OR, odds ratio; SBP, systolic blood pressure.

Table 2 Daily administered drugs in the three subgroups (accidental falls, syncope, and unexplained falls)

Drug type	Accidental falls (n=403) (%)	Syncope (n=210) (%)	Unexplained falls (n=111) (%)	Total (N=724) (%)
AH drugs	59.2a	70.3	64.2	63.2
ACEI–ARBs	34.8a	44	35.8	37.6
Ca-blocker DHP	11.9	11.5	15.6	12.4
Ca-blocker NDHP	5.0	2.9	5.5	4.4
Beta-blockers	1,742	24.9	16.5	19.4
Alpha blocker	6.2a	13.4	10.1	8.9
Diuretics	25.4a	36.8	30.3	29.4
Nitrates	7.2a	13.4c	3.7	8.5
Antiarrhythmics	6.5	10.5	11.0	8.3
Digoxine	5.2	4.8	6.4	5.3
Hypoglycemic agents	15.2	17.2	16.4	16.0
Psychotropic drugs	38.3	33.5c	50.0	38.4
Antihistamines	2.2	1.0	3.7	2.1
Anticholinergic	1.0	2.9	2.8	1.8
Antidepressive	21.4	14.4	24.8	19.9
Sedative–hypnotic drugs	14.9b	12c	29.4	16.3
Antipsychotic	5.2	5.3	8.3	5.7
Antiepilectic/GABAergic	7.5b	7.2c	18.3	9.0
AChEi	1.5	0.5	1.8	1.3

Notes:

a Accidental falls vs syncope (P<0.05, Bonferroni corrected).

b Accidental falls vs unexplained falls (P<0.05, Bonferroni corrected).

c Syncope vs unexplained falls (P<0.05, Bonferroni corrected).

Abbreviations: ACEI–ARBs, angiotensin-converting enzyme inhibitor and angiotensin II receptor blockers; AChEi, acetylcholinesterase inhibitor; AH, antihypertensive; BDZ, benzodiazepine; DHP, dihydropyridine; NDHP, nondihydropyridine.

Table 3 Multiregression analysis (backward)

Analysis	Variables	Accidental falls vs unexplained falls					Analysis	Variables	Accidental falls vs syncope					Analysis	Variables	Unexplained falls vs syncope
		B	P-value	OR	OR, 95% CI				B	P-value	OR	OR, 95% CI				B	P-value	OR	OR, 95% CI
					Lower	Upper						Lower	Upper						Lower	Upper
Step 1	Depression	0.30	0.38	1.35	0.70	2.61	Step 1	Age	−0.02	0.13	0.98	0.96	1.01	Step 1	Gender	−0.65	0.02	0.52	0.30	0.89
	Number of CNS drugs	0.24	0.05	1.28	1.00	1.63		Gender (female)	−0.84	0.00	0.43	0.29	0.63		Musculoskeletal disease	−0.90	0.01	0.41	0.21	0.79
								Musculoskeletal disease	−0.93	0.00	0.40	0.23	0.67
	Number of drugs	0.07	0.08	1.07	0.99	1.17									Dementia	−0.76	0.17	0.47	0.16	1.39
								Dementia	−1.05	0.02	0.35	0.15	0.84		SBP >110 mmHg	−1.35	0.00	0.26	0.12	0.54
Step 3	Number of CNS drugs	0.36	0.00	1.44	1.17	1.77		Valvulopathy	0.85	0.06	2.33	0.96	5.65		Number of CNS drugs	−0.40	0.00	0.67	0.51	0.87
								CHD	0.01	0.97	1.01	0.58	1.75
								CIRS-S	0.07	0.28	1.07	0.95	1.21	Step 2	Gender	−0.65	0.02	0.52	0.30	0.89
								SBP >110 mmHg	−1.15	0.00	0.32	0.20	0.51		Musculoskeletal disease	−0.93	0.01	0.40	0.20	0.77
								Number of drugs	0.00	0.93	1.00	0.93	1.09
								Number of AHs	0.21	0.03	1.24	1.02	1.50		SBP >110 mmHg	−1.34	0.00	0.26	0.13	0.55
								Gender	−0.92	0.00	0.40	0.27	0.58		Number of CNS drugs	−0.43	0.00	0.65	0.50	0.84
							Step 6	Musculoskeletal disease	−0.91	0.00	0.40	0.24	0.68
								Dementia	−1.06	0.02	0.35	0.14	0.82
								Valvulopathy	0.92	0.03	2.51	1.07	5.90
								SBP >110 mmHg	−1.17	0.00	0.31	0.20	0.49
								Number of AH	0.21	0.01	1.24	1.07	1.44

Note: Probability for stepwise entry and removal =0.05.

Abbreviations: AHs, antihypertensive drugs; CHD, coronary heart disease; CI, confidence interval; CIRS-S, Cumulative Illness Rating Scale Severity; CNS, central nervous system; OR, odds ratio; SBP, systolic blood pressure.