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polypharmacy and syncope

Snezana Kusljic, Sachin Perera, Elizabeth Manias
Background/Study context: We investigated various parameters related to falls including age-dependent physiological changes, regular medicine use and different types of falls experienced. There is a lack of research investigating the impact of health status, sex, polypharmacy and ageing on different types of falls such as unspecified fall on the same level, mechanical fall on the same level relating to slipping, tripping or loosing balance, fall from a chair, vehicle and fall as a result of syncope, fall from steps or stairs and fall from the height...
March 28, 2018: Experimental Aging Research
Thomas M Roston, Dat T Tran, Shubhayan Sanatani, Roopinder Sandhu, Robert Sheldon, Padma Kaul
BACKGROUND: The prevalence, hospitalization patterns, and outcomes of pediatric and adolescent syncope have not been rigorously characterized. METHODS: Patients < 20 years presenting to an emergency department (ED) with a primary diagnosis of syncope (International Classification of Diseases, 10th revision, code R55) between fiscal year (FY) 2006/2007 and FY 2013/2014 in the province of Alberta, Canada were grouped according to discharge status from the ED, ie, (1) admitted to hospital and (2) discharged without admission...
February 2018: Canadian Journal of Cardiology
Nandu Goswami, Andrew P Blaber, Helmut Hinghofer-Szalkay, Jean-Pierre Montani
Orthostatic challenge produced by upright posture may lead to syncope if the cardiovascular system is unable to maintain adequate brain perfusion. This review outlines orthostatic intolerance related to the aging process, long-term bedrest confinement, drugs, and disease. Aging-associated illness or injury due to falls often leads to hospitalization. Older patients spend up to 83% of hospital admission lying in bed and thus the consequences of bedrest confinement such as physiological deconditioning, functional decline, and orthostatic intolerance represent a central challenge in the care of the vulnerable older population...
2017: Frontiers in Physiology
Caterina Trevisan, Patrizia Di Gregorio, Eugenio Debiasi, Martina Pedrotti, Mario La Guardia, Enzo Manzato, Giuseppe Sergi, Albert March
BACKGROUND: While the relevance of falls in raising the risk of fractures, hospitalization and disability in older age is well recognized, the factors influencing the onset of fractures and the need for ward admission after a fall have yet to be fully elucidated. We investigated which factors and fall dynamics were mainly associated with fall-related injuries and hospitalization among elderly persons accessing the Emergency Department (ED) following a fall. METHODS: The study involved 2144 older subjects who accessed the ED after a fall...
October 2017: Gait & Posture
Jennifer Juxiang Huang, Chirag Desai, Nirmal Singh, Natasha Sharda, Aaron Fernandes, Irbaz Bin Riaz, Joseph S Alpert
BACKGROUND: While antihypertensive therapy is known to reduce the risk for heart failure, myocardial infarction, and stroke, it can often cause orthostatic hypotension and syncope, especially in the setting of polypharmacy and possibly, a hot and dry climate. The objective of the present study was to investigate whether the results of our prior study involving continued use of antihypertensive drugs at the same dosage in the summer as in the winter months for patients living in the Sonoran desert resulted in an increase in syncopal episodes during the hot summer months...
October 2015: American Journal of Medicine
Andrea Ungar, Chiara Mussi, Franco Nicosia, Alice Ceccofiglio, Giuseppe Bellelli, Mario Bo, Daniela Riccio, Francesco Landi, Anna Maria Martone, Assunta Langellotto, Giulia Ghidoni, Gabriele Noro, Pasquale Abete
BACKGROUND AND AIM: Syncope and related falls are one of the main causes and the predominant cause of hospitalization in elderly patients with dementia. However, the diagnostic protocol for syncope is difficult to apply to patients with dementia. Thus, we developed a "simplified" protocol to be used in a prospective, observational, and multicenter study in elderly patients with dementia and transient loss of consciousness suspected for syncope or unexplained falls. Here, we describe the protocol, its feasibility and the characteristics of the patients enrolled in the study...
December 2015: Aging Clinical and Experimental Research
Veronika van der Wardt, Pip Logan, Simon Conroy, Rowan Harwood, John Gladman
BACKGROUND: The range and magnitude of potential benefits and harms of antihypertensive treatment in people with dementia has not been previously established. METHODS: A scoping review to identify potential domains of benefits and harms of antihypertensive therapy in people with dementia was undertaken. Systematic reviews of these domains were undertaken to examine the magnitude of the benefits or harms. RESULTS: Potential outcome domains identified in the 155 papers in the scoping review were cardiovascular events, falls, fractures and syncope, depression, orthostatic hypotension, behavioral disturbances, polypharmacy risks, kidney problems, sleep problems, interactions with cholinesterase inhibitors, and pain...
September 2014: Journal of the American Medical Directors Association
Martin Huth Ruwald, Morten Lock Hansen, Morten Lamberts, Carolina Malta Hansen, Anna-Karin Numé, Michael Vinther, Lars Køber, Christian Torp-Pedersen, Jim Hansen, Gunnar Hilmar Gislason
Recurrent syncope is a major cause of hospitalizations and may be associated with cardiovascular co-morbidities. Despite this, prognostic factors and the clinical characteristics among patients are not well described. Therefore, we identified and analyzed data on all patients >50 years of age discharged after a first-time episode of syncope in the period 2001 to 2009 through nationwide administrative registries. We identified the clinical characteristics of 5,141 patients ≥85 years of age and 23,454 patients <85 years of age...
November 15, 2013: American Journal of Cardiology
Andrea L Rosso, Charles B Eaton, Robert Wallace, Rachel Gold, Marcia L Stefanick, Judith K Ockene, J David Curb, Yvonne L Michael
OBJECTIVES: To determine how the number of geriatric syndromes is associated with incident disability in community-based populations of older adults. DESIGN: Longitudinal analysis from the Women's Health Initiative Observational Study (WHI-OS). SETTING: Community. PARTICIPANTS: Twenty-nine thousand five hundred forty-four women aged 65 and older enrolled in the WHI-OS and free of disability in activities of daily living (ADLs) at baseline...
March 2013: Journal of the American Geriatrics Society
Jeffrey R Boris
Dysfunction of the autonomic nervous system, or dysautonomia, is an uncommon disease. Postural orthostatic tachycardia syndrome is one of the several types of dysautonomia. Postural orthostatic tachycardia syndrome, also known as chronic orthostatic intolerance, is the most common but least severe of the dysautonomic disorders; it will serve as the model for evaluation and management of the other dysautonomias. Overall, these patients can have variable dysfunction of the autonomic nervous system that is more severe than that observed in typical neurocardiogenic syncope...
December 2010: Cardiology in the Young
Peter Dovjak, Ulrike Sommeregger, Ronald Otto, Regina E Roller, Birgit Böhmdorfer, Bernhard Iglseder, Ursula Benvenuti-Falger, Monika Lechleitner, Markus Gosch
Quality improvement in cardiology over the past decade focused on management of acute coronary syndrome with invasive and innovative medical therapies, optimizing treatment of congestive heart failure and the development of repair procedures in valvular heart disease. On the other hand cardiologist and the attendant physicians are confronted with changes in the characteristics of patients in the light of demographic facts. Comorbidity and polypharmacy raise the need for clear concepts. Therapeutic and diagnostic tools of geriatric medicine may help in that context...
June 2010: Wiener Medizinische Wochenschrift
J Bolbrinker, G Schedensack, M Kölzsch, J Breckwoldt, H-R Arntz, R Kreutz
OBJECTIVE: The aim of this study was to assess drug prescriptions and renal function in a cohort of geriatric emergency patients with a focus on antihypertensive drug treatment. PATIENTS AND METHODS: The one-year observational study was conducted among patients from nursing and retirement homes or outpatient care who were treated by the emergency medical service. Overall, 109 patients (85 women, mean age 85+/-8 years) were studied. Glomerular filtration rate was estimated (eGFR) on the basis of creatinine and cystatin C serum concentrations...
April 2009: Deutsche Medizinische Wochenschrift
Huub A A M Maas, Maryska L G Janssen-Heijnen, Marcel G M Olde Rikkert, A N Machteld Wymenga
Comprehensive geriatric assessment (CGA) is a process that consists of a multidimensional data-search and a process of analyzing and linking patient characteristics creating an individualized intervention-plan, carried out by a multidisciplinary team. In general, the positive health care effects of CGA are established, but in oncology both CGA and the presence of geriatric syndromes still have to be implemented to tailor oncological therapies to the needs of elderly cancer patients. In this paper the conceptualization of geriatric syndromes, their relationship to CGA and results of clinical studies using CGA in oncology are summarized...
October 2007: European Journal of Cancer
Biju Paul, Zbigniew Gieroba, Arduino A Mangoni
BACKGROUND: The tilt table test (TTT) is a useful diagnostic tool in people with unexplained syncope, dizziness, and falls. However, preexisting comorbidities and medications affecting hemodynamic response might affect TTT outcome (i.e. presence or absence of vasomotor syncope). We studied the influence of these compounding factors on TTT outcome. METHODS: One hundred and sixty-four elderly patients with a mean (+/-SD) age of 80.0 +/- 6.1 years (M:F 104:60) underwent TTT...
April 2007: Pacing and Clinical Electrophysiology: PACE
Alan Berkowitz
Treatment of elderly patients with dementia-related behavioral disturbances and depression-related psychosis poses a significant problem, considering patients' frailty and use of polypharmacy for comorbid medical disorders. This case series describes the use of ziprasidone, a novel atypical antipsychotic, in three frail, elderly patients admitted to the hospital for behavioral disturbances secondary to dementia-related illness after their current treatment failed to improve symptoms or produced intolerable side effects...
November 2003: Journal of Psychiatric Practice
Marian T Hannan, Debbie M Cheng, Emily Green, Cherie Swift, Clinton T Rubin, Douglas P Kiel
Non-pharmacologic approaches to prevent bone loss are well suited for elderly patients to avoid polypharmacy and medication side effects. One potential treatment is a vibrating platform that delivers low-level mechanical loading stimulating bone remodeling. However, compliance is a major concern with any daily treatment, and is unknown for an elderly group using this device. Thus we assessed compliance with standing 10 min/day on a vibrating platform device in elderly women, the target population for osteoporosis therapy...
November 2004: Osteoporosis International
Rose Anne Kenny
Syncope is more common in older persons than in any other age group. Age-related physiologic impairments of heart rate, blood pressure, baroreflex sensitivity, and cerebral blood flow, in combination with a higher prevalence of comorbid disorders and concomitant medications, account for the increased susceptibility of older persons to syncope. A number of age-related factors confound the assessment of syncope in older persons. Examples include (1). more than one possible attributable diagnosis; (2). polypharmacy; (3)...
September 2003: Journal of Cardiovascular Electrophysiology
R Grad, B Segal
No abstract text is available yet for this article.
July 2001: Canadian Family Physician Médecin de Famille Canadien
F Puisieux, H Bulckaen, A L Fauchais, S Drumez, F Salomez-Granier, P Dewailly
BACKGROUND: Postprandial hypotension (PPH) is increasingly recognized as a common cause of falls and syncope in elderly persons. Noninvasive ambulatory blood pressure monitoring (ABPM) has been recommended for detecting PPH. This study investigates postprandial blood pressure (BP) changes by means of ABPM in elderly patients experiencing falls or syncopes. METHODS: Twenty-four-hour ABPM was performed in 156 inpatients (111 women, mean age 80.4 +/- 8.1 years). Among them, 45 had been admitted for falls and 75 for syncope; 36 with no history of falls or syncope served as controls...
September 2000: Journals of Gerontology. Series A, Biological Sciences and Medical Sciences
M Linzer, E H Yang, N A Estes, P Wang, V R Vorperian, W N Kapoor
PURPOSE: To review the literature on diagnostic testing in syncope and provide recommendations for a comprehensive, cost-effective approach to establishing its cause. DATA SOURCES: Studies were identified through a MEDLINE search (1980 to present) and a manual review of bibliographies of identified articles. STUDY SELECTION: Papers were eligible if they addressed diagnostic testing in syncope or near syncope and reported results for at least 10 patients...
June 15, 1997: Annals of Internal Medicine
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