Cardiovascular Disorders and Falls Among Older Adults: A Systematic Review and Meta-Analysis.
Bourke R., Doody P., Pérez S., Moloney D., Lipsitz L., Kenny RA.
BACKGROUND: Falls are a common cause of injury, hospitalisation, functional decline, and residential care admission among older adults. Cardiovascular disorders are recognised risk factors for falls. This systematic review assesses the association between cardiovascular disorders and falls in older adults. METHODS: Systematic searches were conducted on MEDLINE and EMBASE, encompassing all literature published prior to 31/12/2022. Included studies addressed persons aged 50 years and older, and assessed the association between cardiovascular disorders and falls or the efficacy of cardiovascular based interventions to reduce falls. Two reviewers independently extracted data and assessed study quality utilising a modified Newcastle-Ottawa scale for observational studies, and the Cochrane Risk of Bias 2 tool for interventional studies. A systematic narrative analysis of all cardiovascular outcomes, and meta-analyses of unadjusted odds ratios were performed. RESULTS: 184 studies were included: 181 observational, three interventional. Several cardiovascular disorders, including stroke, coronary artery disease, valvular heart disease, arterial stiffness, arrhythmia, orthostatic hypotension, and carotid sinus hypersensitivity were consistently associated with falls. In meta-analysis of unadjusted odds ratios (ORs) the largest positive pooled associations with falls during a 12-month reporting interval were for stroke (OR: 1.90, 95% CI 1.70-2.11), peripheral arterial disease (OR: 1.82, 95% CI: 1.12-2.95), atrial fibrillation (OR: 1.52 , 95% CI: 1.27-1.82), and orthostatic hypotension (OR: 1.39, 95% CI: 1.18-1.64). CONCLUSIONS: Several cardiovascular disorders are associated with falls. These results suggest the need to incorporate cardiovascular assessments for patients with falls. This review informed the cardiovascular recommendations in the new World Guidelines for falls in older adults.