Falls, chronic diseases, and drug use in elderly womenBMJ 2003; 327 doi: https://doi.org/10.1136/bmj.327.7426.1288-a (Published 27 November 2003) Cite this as: BMJ 2003;327:1288
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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
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
Lucy Nicholson, Specialist Registrar in Palliative Medicine.
Mike Bennett, Consultant in Palliative Medicine ,St Gemmas Hospice Leeds.
Competing interests none declared
1.Lawlor DA, Patel R.,Ebrahim S.,Association between falls in elderly
women and chronic diseases and drug use:cross sectional study. BMJ
Competing interests: No competing interests