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Rose Anne Kenny

Publications and source records attributed to Rose Anne Kenny.

15 recordsLinked to original sources
PubMed2003

Multifactorial intervention after a fall in older people with cognitive impairment and dementia presenting to the accident and emergency department: randomised controlled trial.

OBJECTIVE: To determine the effectiveness of multifactorial intervention after a fall in older patients with cognitive impairment and dementia attending the accident and emergency department. DESIGN: Randomised controlled trial. PARTICIPANTS: 274 cognitively impaired older people (aged 65 or over) presenting to the accident and emergency department after a fall: 130 were randomised to assessment and intervention and 144 were randomised to assessment followed by conventional care (control group). SETTING: Two accident and emergency departments, Newcastle upon Tyne. MAIN OUTCOME MEASURES: Primary outcome was number of participants who fell in year after intervention. Secondary outcomes were number of falls (corrected for diary returns), time to first fall, injury rates, fall related attendances at accident and emergency department, fall related hospital admissions, and mortality. RESULTS: Intention to treat analysis showed no significant difference between intervention and control groups in proportion of patients who fell during 1 year's follow up (74% (96/130) and 80% (115/144), relative risk ratio 0.92, 95% confidence interval 0.81 to 1.05). No significant differences were found between groups for secondary outcome measures. CONCLUSIONS: Multifactorial intervention was not effective in preventing falls in older people with cognitive impairment and dementia presenting to the accident and emergency department after a fall.

Accidental Falls↗
PubMed2003

Syncope in the elderly: diagnosis, evaluation, and treatment.

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). cardiovascular and cerebrovascular comorbidity; (4). amnesia for loss of consciousness; (5). lack of witness accounts; (6). syncopal events presenting as falls; and (7). coexistent cognitive impairment and dementia. Cardiovascular risk factors are increasingly recognized as key triggers for dementia, with enormous potential for early detection and intervention. One such possible risk factor is bradyarrhythmia. Successful interventions for cardiovascular disorders that cause syncope in the elderly have wider implications than control of syncopal events and include reductions in falls and possibly prevention or modification of cognitive impairment and dementia.

Accidental Falls↗
PubMed2003

The use of an implantable loop recorder in the investigation of unexplained syncope in older people.

INTRODUCTION: Reveal is a patient activated implantable loop recorder device with an 18 month battery life now available to assist in the diagnosis of suspected syncope or arrhythmias. We present our experience using this device in older subjects referred to a dedicated falls and syncope clinic in whom usual clinical assessment had not satisfactorily identified an attributable diagnosis but where we still suspected a cardiovascular cause for syncope or falls. METHODS AND RESULTS: during the past 3 years 15 subjects (mean age 73 years, range 61-89 years) had Reveal implanted for symptoms of syncope alone (n=6; 40%) and unexplained falls (n=3; 20%) or symptoms of syncope and unexplained falls (n=6; 40%). Symptom duration was long (mean 48 months; range 4-200 months). Subjects had experienced significant morbidity, 6 subjects (40%) required A&E attendance or hospital admission and 4 (27%) experienced a fracture. Despite extensive and repeated investigations, which included 12-lead ECG, echocardiogram, 24-h ambulatory heart rate monitor, 24-h ambulatory blood pressure monitor, orthostatic blood pressure measurement, supine and erect carotid sinus massage, electroencephalogram, and passive and GTN head up tilt testing, the attributable diagnosis remained unexplained. Of the 15 subjects, 7 have activated the device at 4 (range 0-14) months after implantation. Bradycardia was identified in 3 and ventricular tachycardia in 1 subject. Two subjects did not activate the device during the 18 months it was in-situ. Four people had problems with device activation. This is comparable to rates noted using Reveal in younger subjects. CONCLUSION: Reveal offers additional diagnostic yield in complex elderly subjects with suspected cardiovascular causes of syncope or unexplained falls which have not been previously satisfactorily diagnosed despite extensive investigations.

Accidental Falls↗
PubMed2003

A prospective evaluation of bone mineral density measurement in females who have fallen.

BACKGROUND: The National Service Framework for Older Persons recognises the relationship between falls and osteoporosis; however, the best method for the evaluation of bone mineral density measurement in fallers is unclear. Dual energy X-ray absorptiometry of lumbar spine and hip is the gold standard for bone mineral density measurement, but is time consuming and may not be readily available. A cheaper, more portable alternative is peripheral dual energy X-ray absorptiometry of the heel. This predicts overall fracture risk as effectively as dual X-ray at the spine and hip, although site specific measurements provide the best estimate of fracture risk at a particular location. AIMS: 1. To validate peripheral dual energy X-ray in fallers by comparing heel bone mineral density measurement with measurements obtained at the lumbar spine and hip. 2. To determine the prevalence of osteoporosis in an unselected cohort of fallers. METHODS: 118 consecutive females over 50 attending for investigation of falls had heel bone mineral density measurement measured using peripheral dual energy X-ray (PIXI, Lunar). A representative sample of 52 (44%) also attended for bone mineral density measurement at the hip and lumbar spine using Hologic QDR 4500. Bone mineral density (g/cm(2)) measurements were compared with mean values for young adults and age-related normals giving T (number of standard deviation units above or below the mean for normal young adults) and Z (number of standard deviations above or below the age-related normal mean) scores. RESULTS: In the total group [n = 118 mean (SD) age 74 (11)] heel bone mineral density was 0.4 (0.1), T score--1.1 (1.6) and Z score--0.1 (1.5). The relationship between absolute bone mineral density measurements taken at heel, total hip and lumbar spine were compared and the correlation coefficients show a strong positive relationship between all measurements (all r values > 0.54, P < 0.0001) with a particularly strong relationship between hip and heel (r = 0.74). Those with two or more risk factors for falls were significantly more likely to have lower bone mineral density. DISCUSSION: This study has shown that peripheral dual energy X-ray is a reliable method of assessment, applicable to use within a Falls Unit. In addition, although the prevalence of osteoporosis is not increased in unselected fallers, those with two or more risk factors for falls are at increased risk of osteoporosis and limited resources may be more appropriately targeted toward this group.

Absorptiometry, Photon↗
PubMed2003

Hyperintensities and fronto-subcortical atrophy on MRI are substrates of mild cognitive deficits after stroke.

AIM: The current study determines the MRI correlations of the early neuropsychological post-stroke cognitive deficits. METHOD: Detailed neuropsychological assessments (attention and working memory) were undertaken in 50 stroke survivors >75 years of age [38 with ageing-associated cognitive decline (AACD)] and 15 age-matched controls. A 1.5-tesla General Electric MRI scanner was used. Standardized visual ratings were undertaken of white matter hyperintensities (WMH). Grey matter volumes were assessed using voxel-based morphometery. RESULTS: Associations were identified between processing speed and executive function and the severity of WMH in key areas. In addition, atrophy in the fronto-subcortical circuits was associated with AACD. CONCLUSION: Attentional and executive impairments are underpinned by WMH in fronto-striato-thalamo-frontal circuits. Frontal atrophy is identified as a novel substrate of cognitive decline in stroke patients.

Aged↗
PubMed2002

Clinical characteristics of unexplained syncope and their relationship to tilt table test outcomes.

AIMS: To describe the clinical characteristics of patients presenting to a tertiary referral centre undergoing tilt table testing (HUT), comparing those who have vasovagal syncope (VVS) confirmed as a cause of symptoms and those with unexplained syncope after HUT. DESIGN: Prospective study of consecutive patients presenting to a regional tertiary referral centre, with more than two episodes of unexplained syncope in the past year. Detailed semi-structured questionnaires were completed regarding presenting symptoms, prodromal features and precipitating factors. RESULTS: Eighty-seven patients were studied, 31 had positive passive head up tilt (HUT), 31 positive provocative HUT (either sublingual glyceryl trinitrate or intravenous isoprenaline) and in 25 patients, syncope remained unexplained at the end of tilt testing. Characteristics of patients with positive passive HUT did not differ significantly from those requiring pharmacological provocation, although passive HUT patients were more likely to have classical prodrome and precipitants. The clinical characteristics of those whose syncope remained unexplained differed from those who had VVS confirmed by tilt table testing, in particular symptoms after syncope were less common and clustering of episodes was unlikely. Prodrome was absent in over 80 % of the "unexplained" group. CONCLUSIONS: Clinical characteristics of patients with unexplained syncope and negative tilt tests differ from those with positive tilt studies. Further cardiovascular testing should be undertaken in this group to determine other causes of syncope.

Adult↗
PubMed2002

Neurally mediated syncope.

The prevalence and incidence of syncope increases with advancing years due to age related physiological changes in the neurocardiovascular, endocrine and renal systems. Cardiovascular syncope can present as falls because of amnesia for loss of consciousness or postural instability due to hypotension. Drop attacks or non accidental falls should thus be investigated for causes of syncope. The most common causes of neurally mediated syncope in older adults are carotid sinus syndrome, orthostatic hypotension and vasovagal syncope.

Accidental Falls↗
PubMed2002

Presence of a carotid bruit in adults with unexplained or recurrent falls: implications for carotid sinus massage.

BACKGROUND: Carotid sinus hypersensitivity is a common cardiovascular cause of unexplained or recurrent falls in older adults. Effective treatment is available once carotid sinus hypersensitivity is identified. Carotid sinus massage is the only practical method for achieving a diagnosis. Carotid sinus massage is contraindicated if a carotid bruit is present. OBJECTIVE: To determine the prevalence of carotid sinus hypersensitivity in adults presenting with unexplained or recurrent falls and a carotid bruit. DESIGN: Prospective consecutive cohort study. SETTING: Accident and Emergency department and regional syncope and falls facility. SUBJECTS: Accident and Emergency patients aged 50 years or over with unexplained or recurrent falls and a carotid bruit. INTERVENTION: 1) Carotid doppler ultrasound to identify significant stenosis (> or = 50%). 2) Carotid sinus massage (with electrocardiographic and phasic blood pressure monitoring) was performed supine and possibly upright. METHODS: Consecutive adults with unexplained or recurrent falls were screened for carotid bruits. Those with a carotid bruit were referred for carotid Doppler ultrasound and stratified for further investigation depending on presence and degree of underlying carotid artery stenosis. Carotid sinus massage was performed at least supine in those with up to moderate stenosis (50-69%) in either internal or common carotid artery. MAIN OUTCOME MEASURE: Diagnosis of carotid sinus hypersensitivity. RESULTS: We identified 1682 subjects with unexplained or recurrent falls of whom 179 (11%) had a carotid bruit, 167 underwent ultrasound, 31% had a stenosis > or = 50% (20% > or = 70%) in either internal or common carotid artery. A bruit was associated with significant ipsilateral stenosis in 25% and contralateral silent stenosis in a further 5%. Carotid sinus massage was performed in 121 subjects who were suitable (15 with moderate carotid artery stenosis). Carotid sinus hypersensitivity was found in 41 (34%) subjects (4 with moderate stenosis). No serious complications occurred following carotid sinus massage. CONCLUSIONS: Carotid sinus hypersensitivity is a possible attributable cause of symptoms in a third of subjects with unexplained or recurrent falls and carotid bruits. Only a small number have severe carotid artery stenosis. Ultrasound will identify high-risk subjects and facilitate accurate diagnosis with carotid sinus massage in the majority.

Accidental Falls↗
PubMed2002

Neuropsychological deficits in older stroke patients.

This paper examines the frequency of CIND, the profile of early cognitive deficits in stroke patients, the differences in the profile of cognitive impairment in people with CIND and those with vascular dementia, and the MRI associations of CIND in older stroke patients.

Aged↗
PubMed2002

Vasovagal syncope masquerading as unexplained falls in an elderly patient.

The authors report the case of a 78-year-old woman who had recurrent, unexplained falls. No witness account of these episodes was available. During head-up tilt testing, the patient had vasodepressor vasovagal syncope. Afterwards, she had amnesia from loss of consciousness. Her symptoms (falls) responded to the withdrawal of culprit medications.

Accidental Falls↗
PubMedDate not supplied

Circadian and orthostatic blood pressure is abnormal in the carotid sinus syndrome.

The authors' objective was to determine circadian blood pressure behavior and the prevalence of orthostatic hypotension in patients with cardioinhibitory carotid sinus syndrome. A prospective consecutive series of 160 patients (mean age, 72 [65-83]) with recurrent syncope attributed to cardioinhibitory carotid sinus syndrome was recruited. Mean maximal slowing of heart rate was 4.5 seconds (3.0-5.5 seconds) during carotid sinus massage. Patients had cardiovascular assessments, including 24-hour ambulatory blood pressure measurements (recordings every half-hour during daytime, hourly at night) and morning orthostatic blood pressures before pacemaker implants. Ambulatory measurements were compared with those of 98 age- and sex-matched controls. Nocturnal systolic blood pressure (130.0+/-21.0 vs. 122.1+/-16.7 mm Hg; p<0.005), diastolic blood pressure (72.8+/-12.5 vs. 68.7+/-9.7 mm Hg; p<0.005), and heart rate (66.5+/-9.4 vs. 65.2+/-9.7 bpm; p<0.005), were significantly higher in patients and independent of cardiovascular medication, cardiovascular diagnoses, and orthostatic hypotension. Almost one half of carotid sinus syndrome patients also had orthostatic hypotension. Blood pressure behavior is abnormal in patients with carotid sinus syndrome as represented by altered nocturnal blood pressures and high prevalence of orthostatic hypotension.

Aged↗
PubMedDate not supplied

The prevalence of falls in older persons paced for atrioventricular block and sick sinus syndrome.

Falls are a major health priority. Eight percent of persons over age 70 present to emergency departments each year due to a fall; fall-related injuries account for 6% of all medical expenditures for persons age 65 and older in the United States. Pacing reduces falls by 70% in patients with cardioinhibitory carotid sinus hypersensitivity. The prevalence of falls in other bradyarrhythmic disorders is not known. The purpose of the following study was to compare the prevalence of falls in older adults with atrioventricular block and sick sinus syndrome with case controls. Consecutive subjects who had pacemakers implanted for atrioventricular block and sick sinus syndrome were assessed. Age and gender-matched admissions to the coronary care unit were similarly studied. Eighty-one subjects were included in the study, 31 paced and 50 controls. There were 134 falls in the bradyarrhythmic group and 12 in the control group. The authors conclude that this is the first series that clearly shows a significant association between atrioventricular block, sick sinus syndrome, and falls. Further prospective studies are needed to substantiate these results.

Accidental Falls↗