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.

From the reflected spectrum to the properties of a fiber Bragg grating: a genetic algorithm approach with application to distributed strain sensing.

We describe a genetic algorithm approach to solve an inverse problem in optics, which determines the characteristics of a fiber Bragg grating from its reflected spectrum. The validity of the proposed method is demonstrated by use of a Bragg sensor for the measurement of nonlinear strain acting on a uniaxial aluminum test specimen.

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.

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.

Impact of a dedicated syncope and falls facility for older adults on emergency beds.

Background: syncope and falls are common symptoms in older adults. Dedicated facilities for these symptoms are emerging in the UK. To date, justification for resource allocation for these day case facilities is lacking.

Prevalence of hypotensive disorders in older patients with a pacemaker in situ who attend the Accident and Emergency Department because of falls or syncope.

Aims: To ascertain the proportion of adults with a pacemaker in situ attending the Accident and Emergency Department because of syncope or unexplained falls and the cause of index symptoms in these patients, including the prevalence of hypotensive syndromes.

Methods And Results: Patients presenting to the Accident and Emergency Department with unexplained syncope or non-accidental falls, who had a pacemaker in situ, were studied. Eligible patients had cardiovascular assessment (morning orthostatic blood pressure measurement, heart rate and BP measurements during carotid sinus stimulation (supine and upright), head-up tilt at 70 degrees for 40 min), assessment of haemodynamics during fixed mode pacing and gait and balance assessment.

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.

Toward a better death: applying Burkean principles of symbolic action to interpret family adaptation to Karen Ann Quinlan's coma.

This article considers the manner that families come to accept the collapse of identity in a family member who has entered a medical crisis with no hope of returning from it. The transformation is regarded as a "right of passage" and is characterized in terms of both the conditions that bring about resistance to the passage as well as the sorts of symbolic activities that ultimately allow the transformation to occur. The theoretical source that is used to discuss both these issues is Kenneth Burke's (1969) theory of Dramatism, regarded herein as a template that guides both interpersonal action and experience.

Syncope and falls in older people: defining the size of the problem.

The proportion of the population over the age of 65 is increasing. Reducing diseases that are common in this age group and that are associated with morbidity and mortality is a priority, if healthcare budgets are to be used cost-effectively. Syncope and falls are common in older people and are a major cause of healthcare expenditure.

Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE).

Objectives: The aim of the study was to determine whether cardiac pacing reduces falls in older adults with cardioinhibitory carotid sinus hypersensitivity (CSH).

Background: Cardioinhibitory carotid sinus syndrome causes syncope, and symptoms respond to cardiac pacing. There is circumstantial evidence for an association between falls and the syndrome.

Carotid sinus hypersensitivity is common in older patients presenting to an accident and emergency department with unexplained falls.

Objective: To determine the prevalence of carotid sinus hypersensitivity and orthostatic hypotension in older patients with non-accidental falls attending an accident and emergency department.

Design: A prospective case-control non-randomized study. Data were collected from semi-structured interviews, physical examination and neurocardiovascular investigations.

Clinical characteristics of patients with vasovagal reactions presenting as unexplained syncope.

Objective: To describe the clinical characteristics of vasovagal syncope (VVS) in patients presenting to a tertiary referral centre with unexplained syncope, in whom the diagnosis of VVS was confirmed by tilt table testing (HUT) and in whom other causes of syncope excluded.

Design: Prospective study of 62 consecutive patients with more than two episodes of syncope in the past year.

Setting: A regional tertiary referral centre for patients with unexplained syncope.

Multiple substrates of late-onset dementia: implications for brain protection.

Age is the single most important risk factor for progressive dementia in populations worldwide. In developed countries the prevalence of dementia is estimated to be 3-5% at age 65 years and expected to double every decade thereafter. Although there is ageing-related attrition of neural tissue accompanied by profound changes in brain glia, marked neuronal loss and severe cognitive impairment are associated with pathological changes.

Carotid sinus syndrome and falls in older adults.

Retrospective and circumstantial evidence supports an overlap between symptoms of falls and syncope in older adults. Because of this overlap, we undertook a prospective, explanatory, single-center study of cardiac pacing for falls in patients with carotid sinus syndrome in a consecutive series of over 56,000 adult visitors to an emergency department. One third attended because of a fall; one in five fallers had unexplained falls, and one third of these had carotid sinus hypersensitivity, of whom one half had a cardioinhibitory or mixed response that may be expected to respond to cardiac pacing.