Rapid responses are electronic letters to the editor. They enable our users to debate issues raised in articles published on thebmj.com. Although a selection of rapid responses will be included online and in print as readers' letters, their first appearance online means that they are published articles. If you need the url (web address) of an individual response, perhaps for citation purposes, simply click on the response headline and copy the url from the browser window. Letters are indexed in PubMed.
Editor- Lovell et al demonstrated the importance of chronic diseases
and multiple pathologies as predictors of falling in elderly women at
home.These risk factors were more important predictors for falling than
polypharmacy 1.
We have recently undertaken a Yorkshire Cancer Network survey of
falls in palliative care inpatient settings. We found that the incidence
of falls in this context was 5.7 falls per occupied bed per year,
noticeably higher than the incidence in nursing homes or in the
community.This may reflect the patient population who are often elderly
with other coexisting pathologies. Our study identified cognitive
impairement and low systolic blood pressure as the most important
independent predictors of falls in this context. However, we did not find
any association between falls and various medication groups such as opioid
analgesics as Lovell et al demonstrated.
In common with Lovell, we did not find an association betweem
postural hypotension and falls, despite our assumption that this would be
a frequent association. This might be explained by the fact that patients
with postural hypotension learn to recognise feelings of dizziness and
that allows them to sit down in time to avoid falling. In patients with
impaired cognition this may well not happen. Persistent low systolis blood
pressure, while known to be a factor in cognitive impairement, is also
seen more commonly in people with progressive disease.In palliative care
patients, hypotension and cognitive impairment probably reflect failing
physical systems and more strongly influence falling than medicines.
Hazel Pearse, Specialist Registrar in Palliative Medicine, St James
Hospital Leeds.
Lucy Nicholson, Specialist Registrar in Palliative Medicine.
Mike Bennett, Consultant in Palliative Medicine ,St Gemmas Hospice Leeds.
1.Lawlor DA, Patel R.,Ebrahim S.,Association between falls in elderly
women and chronic diseases and drug use:cross sectional study. BMJ
2003;327:712-717.
Falls and Palliative Care Patients- the importance of chronic diseases.
Editor- Lovell et al demonstrated the importance of chronic diseases
and multiple pathologies as predictors of falling in elderly women at
home.These risk factors were more important predictors for falling than
polypharmacy 1.
We have recently undertaken a Yorkshire Cancer Network survey of
falls in palliative care inpatient settings. We found that the incidence
of falls in this context was 5.7 falls per occupied bed per year,
noticeably higher than the incidence in nursing homes or in the
community.This may reflect the patient population who are often elderly
with other coexisting pathologies. Our study identified cognitive
impairement and low systolic blood pressure as the most important
independent predictors of falls in this context. However, we did not find
any association between falls and various medication groups such as opioid
analgesics as Lovell et al demonstrated.
In common with Lovell, we did not find an association betweem
postural hypotension and falls, despite our assumption that this would be
a frequent association. This might be explained by the fact that patients
with postural hypotension learn to recognise feelings of dizziness and
that allows them to sit down in time to avoid falling. In patients with
impaired cognition this may well not happen. Persistent low systolis blood
pressure, while known to be a factor in cognitive impairement, is also
seen more commonly in people with progressive disease.In palliative care
patients, hypotension and cognitive impairment probably reflect failing
physical systems and more strongly influence falling than medicines.
Hazel Pearse, Specialist Registrar in Palliative Medicine, St James
Hospital Leeds.
Lucy Nicholson, Specialist Registrar in Palliative Medicine.
Mike Bennett, Consultant in Palliative Medicine ,St Gemmas Hospice Leeds.
hazelpearse@hotmail.com
Competing interests none declared
References
1.Lawlor DA, Patel R.,Ebrahim S.,Association between falls in elderly
women and chronic diseases and drug use:cross sectional study. BMJ
2003;327:712-717.
Competing interests:
None declared
Competing interests: No competing interests