Falls and blackouts are a common occurrence but the underlying causes are often misunderstood. A new specialist unit at St James's Hospital, Dublin, is busy trying to come up with some answers, writes Danielle Barron
Falls and blackouts are a common occurrence, so common in fact, that their underlying causes are often not fully investigated. A specialist unit, established in St James's Hospital, Dublin, at the start of last year, aims to unmask the origins of potentially dangerous and distressing falls and blackouts.
The unit's director is Prof Rose Anne Kenny, who had previously established a similar award-winning clinic in Newcastle's Royal Victoria Infirmary.
"The work we did in Newcastle showed that running a dedicated falls and blackout unit significantly reduces emergency admissions to hospital, particularly for older people," says Kenny.
Almost half of all people over 65 who visit A&E do so because of a fall, she adds.
Kenny says her decision to return to Ireland was made on the condition that she would be allowed set up a similar facility here.
"In all European countries that have been studied, falls are cited as the most common reason for elderly people to go into long-term institutional care," explains Kenny.
Falls are often mistakenly accepted as an expected consequence of ageing, she adds.
"But that isn't the case - there is always a cause," she stresses. "The challenge is finding the cause, and that's what we do."
Anybody who comes to A&E having had a blackout or recurrent falls is referred directly to the clinic and is then assessed by the minimum of a doctor and a nurse.
Patients from all parts of the State are also referred to the unit, which is co-funded by the American trust Atlantic Philanthropies, founded by Charles "Chuck" Feeney, and also the Department of Health and Children.
The unit incorporates a multidisciplinary team including consultant physicians, nurses, physiotherapists and occupational therapists. "We assess an average of eight people per day, and sometimes as many as 12," says Kenny. The clinic has now seen more than 1,000 patients, she adds.
A comprehensive investigation of the possible underlying causes of falls is carried out, with a full assessment taking up to an hour and a half for each patient, explains Kenny. Specialist equipment is used to look for heart rate and blood pressure irregularities, and also possible neurological problems.
Blackouts are a very common disorder, explains Kenny. "At some stage in our lives 40 per cent of us will suffer a blackout," she says.
The blackout component of the clinic is extremely valuable, as the underlying reasons for a person suffering blackouts are often mistaken for something else, says Kenny.
"In a significant portion of people on medication for epilepsy, an underlying cardiac cause is in fact to blame for the event. There is a poor awareness of this," she explains.
About one-third of older people who have blackouts, either because of epilepsy or abnormal heart rate or blood pressure, are not aware they've lost consciousness and only recall falling, says Kenny.
Furthermore, some 70 per cent of people have no witness account of the event.
"A blackout is a dramatic event and would generally instigate neurological, heart rate and blood pressure investigations. However, if someone just presents with a fall, it's assumed it was just a slip or a trip," she explains.
Twenty years ago Kenny was responsible for devising the "head-up tilt test", which has since been adopted worldwide as the standard tool for unmasking the cause of blackouts. Before this test, 60 per cent of blackouts remained undiagnosed, says Kenny. "Nowadays with the equipment that we have, and the methodology that we have, we can make a diagnosis in virtually all of blackouts," she says.
Most blackouts are once-offs, and usually the result of tiredness or overheating, explains Kenny. But while the majority are benign, some may have a serious underlying cause.
"Blackouts can be a warning of an underlying heart condition, even in young people, and therefore must be taken seriously if an electrocardiogram [ ECG] is abnormal or if there is a family history of sudden death syndrome," says Kenny.
Treatment for these conditions will include drugs but a small proportion of patients may require a pacemaker, she explains.
"It's important that blackouts and falls are taken seriously. They are such a common problem that every accident and emergency department should have access to a proper falls assessment facility," concludes Kenny.