Age and Ageing, Vol 28, 127-133, Copyright © 1999 by British Geriatrics Society
CR Ward, S McIntosh and RA Kenny
BACKGROUND: the potential impact on morbidity, mortality and health care
economics makes it important to identify patients at risk of fracture, in
particular fractured neck of femur (FNOF). Older patients with carotid
sinus hypersensitivity (CSH) are more likely to have unexplained falls and
to experience fractures, particularly FNOF. Our objective was to determine
the prevalence of CSH in patients with FNOF. DESIGN: case-controlled
prospective series. METHODS: consecutive cases were admissions over 65
years with FNOF. Controls were consecutive patients admitted for elective
hip surgery, frail elderly people admitted to hospital medical wards and
day-hospital patients. All patients had a clinical assessment of cognitive
function, physical abilities and history of previous syncope, falls and
dizziness, in addition to repeated carotid sinus massage with continuous
heart rate and phasic blood pressure measurement. RESULTS: heart rate
slowing and fall in systolic blood pressure was greater for patients with
FNOF than those admitted for elective hip surgery (P < 0.05 and P <
0.001). CSH was present in 36% of the FNOF group, none of the elective
surgery group, 13% of the acutely ill controls and 17% of the outpatients.
It was more likely to be present in FNOF patients with a previous history
of unexplained falls or an unexplained fall causing the index fracture. The
heart rate and systolic blood pressure responses to carotid sinus
stimulation were reproducible. CONCLUSION: older patients with an acute
neck of femur fracture who do not give a clear history of an accidental
fall or who have had previously unexplained falls are likely to have CSH.
CSH may be a modifiable risk factor for older patients at risk of hip
fracture.
ARTICLES
Carotid sinus hypersensitivity--a modifiable risk factor for fractured neck of femur
Department of Medicine (Geriatric Medicine), and Institute for the Health of the Elderly, Royal Victoria Infirmary, Newcastle upon Tyne, UK.
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