Falls Risk, Circadian Rhythms and Melatonin: Current Perspectives

GOSWAMI, NANDU; ABULAFIA, CAROLINA; VIGO, DANIEL; MOSER, MAXIMILIAN; CORNELISSEN, GERMAINE; CARDINALI, DANIEL

Clinical Interventions in Aging

Auckland : Dove Medical Press

Año: 2020 vol. Volume 15 p. 2165 - 2174

Aging is associated with weakening of the circadian system. The circadianamplitude of most physiological variables is reduced, while the circadian phase becomesmore labile and tends to occur earlier with advancing age. As the incidence of falls in olderpersons could follow circadian variations, a better understanding of conditions in which fallsoccur can lead to the implementation of countermeasures (such as adjusting the scheduling ofhospital staff, or changing the timing of anti-hypertensive medication if falls are related toundesirable circadian patterns of blood pressure and/or heart rate). This includes knowing thetimes of the day, days of the week, and times of the year when falls are more likely to occurat home or in the hospital. Additionally, the links between aging processes and factorsassociated with an increased risk of developing autonomic dysfunction are well established.A strong association between heart rate variability indexes and aging has been shown.Circadian rhythms of autonomous nervous system activity may play important role formaintenance of orthostatic tolerance. Whether one is concerned with disease predictionand prevention or maintenance of healthy aging, the study of circadian rhythms and thebroader time structure underlying physiopathology is helpful in terms of screening, earlydiagnosis and prognosis, as well as the timely institution of prophylactic and/or palliative/curative treatment. Timing the administration of such treatment as a function of circadian(and other) rhythms also could lead to reduction of falls in older persons. Finally,a prominent circadian rhythm characterizes melatonin, which peaks during the night. Thecircadian amplitude of melatonin decreases as a function of age, raising the questionswhether such a decrease in the circadian amplitude of melatonin relates to a higher risk offalls and, if so, whether melatonin supplementation may be an effective countermeasure. Thisnarrative review assesses the relationships between fall risk and the potential role circadianrhythms and melatonin play in mitigating this risk. We aim to provide healthcare workersadequate information about fall risk in older persons, including the potential role of thecircadian rhythms and/or melatonin, as well as to lay foundations for future fall preventioninterventional studies.