in individuals with heart failure approaching the end of
life, and there is limited knowledge on the best way to
manage these individuals [49]. The elevated risk of falling
in the elderly with heart failure may be explained by
its pharmacotherapy (e.g. diuretics, ACE inhibitors, betablockers)
and their association with falls, although these
categories of pharmaceuticals did not individually
predict falls in our study. Response to pharmacotherapy
for heart failure varies in elderly individuals, who
are susceptible to adverse events such as orthostatic
hypotension, dehydration, electrolyte disturbance, incontinence
and drug-drug interactions [47]. One common
side effect of diuretics is hyponatraemia, which is associated
with impairment of gait and attention. Stable mild
chronic hyponatraemia is generally considered asymptomatic,
although Renneboog (2006) observed a high number
of falls in comparison to controls in hyponatraemic subjects
considered clinically asymptomatic. Furthermore,
individuals with moderate chronic hyponatraemia fell dramatically
more frequently than patients with normal
serum sodium levels [50].