Cardiovascular responses to orthostasis and their association with falls in older adults

Abstract

BackgroundOrthostatic hypotension (OH) refers to a marked decline in blood pressure when upright. OH has a high incidence and prevalence in older adults and represents a potential intrinsic risk factor for falls in these individuals. Previous studies have not included more recent definitions for blood pressure responses to orthostasis, including initial, delayed, and recovery blood pressure responses. Furthermore, there is little research examining the relationships between cerebrovascular functioning and falling risk. Therefore, we aimed to: (i) test the association between different blood pressure responses to orthostatic stress and retrospective falling history and; (ii) test the association between cerebrovascular responses to orthostatic stress and falling history.MethodsWe tested 59 elderly residents in long term care facilities who underwent a passive seated orthostatic stress test. Beat-to-beat blood pressure and cerebral blood flow velocity (CBFV) responses were assessed throughout testing. Risk factors for falls and falling history were collected from facility records. Cardiovascular responses to orthostasis were compared between retrospective fallers (≥1 fall in the previous year) and non-fallers.ResultsRetrospective fallers had larger delayed declines in systolic arterial pressure (SAP) compared to non-fallers (p = 0.015). Fallers also showed poorer early (2 min) and late (15 min) recovery of SAP. Fallers had a greater decline in systolic CBFV.ConclusionsOlder adults with a positive falling history have impaired orthostatic control of blood pressure and CBFV. With better identification and understanding of orthostatic blood pressure impairments earlier intervention and management can be implemented, potentially reducing the associated risk of morbidity and mortality. Future studies should utilize the updated OH definitions using beat-to-beat technology, rather than conventional methods that may offer less accurate detection.

Validation of Evidence-Based Fall Prevention Programs for Adults with Intellectual and/or Developmental Disorders: A Modified Otago Exercise Program

“…Support staff provided assistance to participants as needed. The functional screens administered were those outlined in the STEADI (32) and included orthostatic hypotension (33–35), Timed Up-and-Go (TUG) Test (36–38), 30-Second Chair Stand Test (39–42), and the 4-Stage Balance Test (13, 43–45). The PIs added the 2-Minute Walk Test as a method to determine aerobic ability of participants (46–48).…”

The relative importance of frailty, physical and cardiovascular function as exercise-modifiable predictors of falls in haemodialysis patients: a prospective cohort study

“…Thus, a reduced frequency of baroreflex activation (i.e. low BEI) would imply that sudden drops in BP are not coupled effectively with concomitant increases of HR, which may result in a suboptimal cerebral perfusion possibly leading to dizziness symptoms and, consequently, falls [39]. Many dialysis-specific or idiopathic risk factors may be involved in the dysregulation of BP which could possibly lead to dizziness symptoms and falls in this clinical population.…”

“…Particularly, the five-minute HUT-60°protocol employed in this study was designed to investigate only the short-lived haemodynamic adjustments to orthostasis [18,47]. Previous research has shown that, during a 15-min passive orthostatic challenge, elderly people with a history of falls tend to exhibit a larger drop of BP compared with nonfallers [39]. Therefore, it is plausible that a longer HUT-60°protocol may have revealed a larger decrement of both contBP and OscBP in fallers [46].…”

Locomotive syndrome is associated with large blood pressure variability in elderly hypertensives: the Japan Ambulatory Blood Pressure Prospective (JAMP) substudy

“…In the present study, the LS scale score was independently associ- tatic hypotension is already established. [23][24][25] It was recently reported that orthostatic hypertension occurs frequently among frail elderly individuals. 26,27 A study of acute hospitalized patients revealed that orthostatic hypertension was associated with favorable outcomes.…”