The School of Medicine at Trinity College Dublin is proud to highlight the innovative research project of Dr Paul Claffey, a clinical fellow in falls and syncope at St. James’s Hospital who recently defended his PhD thesis. His work sheds new light on factors contributing to falls in older adults - a critical health issue associated with many adverse outcomes. Paul’s research focuses on investigating the relationship between orthostatic hypotension (OH), cerebral perfusion, dizzy symptoms, and falls risk.

Accidental falls, fainting and dizziness are common reasons for older people to seek medical care. Sometimes, however, it is not initially clear what has caused an older person to fall – they cannot be explained by a simple trip, slip or loss of balance. What if the root cause of these unexplained falls isn’t just because of balance, but the interplay between blood pressure and cerebral circulation? Paul’s research, under the supervision of Regius Rose Anne Kenny and Dr Ciarán Finucane PhD, addresses a critical gap in our understanding of these impaired physiological mechanisms that contribute to falls. Orthostatic Hypotension (OH) is a condition marked by a significant drop in blood pressure upon standing. OH has been found to be a major cause of unexplained falls, as it is thought to compromise blood flow to the brain when the patient stands upright. Paul’s research aims to investigate the effect of OH on cerebral blood flow during standing, and how this may contribute to the likelihood of falls in the older population.

Using near-infrared spectroscopy (NIRS), an innovative non-invasive tool to measure cerebral tissue oxygenation, Paul's findings confirm that brain blood flow is reduced in individuals with OH when they stand up. Using data collected from The Irish Longitudinal Study on Ageing (TILDA), Paul has also shown that those older people with OH combined with the most markedly reduced cerebral perfusion on standing places them at the greatest risk for future unexplained falls.

Paul's work emphasises the need for personalised clinical approaches in the management of OH in older adults, suggesting that measuring cerebral perfusion alongside orthostatic blood pressure could improve falls assessments and reduce the risk of future falls. This research has the potential to reshape clinical guidelines and healthcare policy for falls prevention, improving the safety and well-being of older patients.

"This research has the potential to transform how we understand, assess, and manage falls risk in older adults, improving both patient outcomes and the care that we as clinicians are always striving to provide," says Paul.

This PhD research project represents an exciting step in falls evaluation in older people ensuring clinicians are better equipped to assess and manage falls risk in their patients. Paul’s work is featured alongside other innovative research projects in the recently published Annual Overview of Doctoral Health Research 2024 by the School of Medicine, Trinity College Dublin.

Dr Paul Claffey