Falls Among Older People: Relationship to Medication Use and Orthostatic Hypotension

Liu, Barbara A.; Topper, Anne; Reeves, Richard; Gryfe, C. I.; Maki, Brian E.

doi:10.1111/j.1532-5415.1995.tb07016.x

Cited by 108 publications

(85 citation statements)

References 33 publications

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“…Clinicians often implicate OH in the aetiology of falls in older people; however, concerns have been expressed that the clinical detection of OH is unlikely to be useful in predicting future risk of falling [27], and a systematic review found that OH does not predict falls after controlling for other factors [28]. Our work suggests that OH could be a marker of frailty; and since frailty is a better predictor of falls than OH, OH could be a useful indicator of the need for multifaceted interventions to target frailty (and, in turn, falls) [29].…”

Section: Discussionmentioning

confidence: 99%

Orthostatic haemodynamics may be impaired in frailty†

Romero-Ortuño¹,

Cogan²,

O’Shea³

et al. 2011

Age and Ageing

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Background: orthostatic hypotension (OH) is a physical sign that reflects a final common pathway of various forms of disordered physiology, which is the hallmark of geriatric frailty. Fried et al. recognise three increasing frailty phenotypes in older people, based on measurements of weight loss, exhaustion, grip strength, walking speed and physical activity. Orthostatic haemodynamics have not been considered as markers of frailty in older people. Objective: to classify a community sample of older people into three increasing frailty phenotypes and compare their orthostatic haemodynamics. Design: cross-sectional study. Setting: geriatric research clinic. Subjects: a total of 442 subjects (mean age 72, 72% females) without dementia or risk factors for autonomic neuropathy. Methods: the sample was classified according to modified Fried criteria. Orthostatic systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) responses were monitored during an active stand with Finometer®. Results: one hundred and ninety-eight subjects (44.8%) were classified as non-frail, 213 (48.2%) as pre-frail, and 31 (7.0%) as frail. Across groups, there was a significant increasing gradient in baseline HR (P = 0.008) and decreasing gradients in Delta HR (i.e. maximum HR within 30 s-baseline HR) (P < 0.001) and maximum HR by 30 s (P < 0.001). On average, by 30 s after stand, non-frail subjects had recovered 98% of their baseline SBP, while pre-frail and frail subjects had recovered 95 and 92%, respectively (P for trend = 0.064). Conclusions: the orthostatic HR response and, to a lesser extent, SBP recoverability, appear impaired in frailty. Orthostatic haemodynamics may be useful markers of frailty.

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Section: Discussionmentioning

confidence: 99%

Orthostatic haemodynamics may be impaired in frailty†

Romero-Ortuño¹,

Cogan²,

O’Shea³

et al. 2011

Age and Ageing

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“…2 Some epidemiological studies have showed that orthostatic hypotension is a risk factor for falls 5 and syncope, 29 whereas others have not. 30,31 One study suggested that assessment of dizziness on standing may be more important as a predictor of functional status, falls, and syncope than measuring postural change in blood pressure in elderly women. 32 Others report a relation between use of antihypertensive medications and orthostatic hypotension 8,33 ; this relation was not seen in our analyses.…”

Section: Discussionmentioning

confidence: 99%

Orthostatic Hypotension Predicts Mortality in Elderly Men

et al. 1998

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Background-Population-based data are unavailable concerning the predictive value of orthostatic hypotension on mortality in ambulatory elderly patients, particularly minority groups. Methods and Results-With the use of data from the Honolulu Heart Program's fourth examination (1991 to 1993), orthostatic hypotension was assessed in relation to subsequent 4-year all-cause mortality among a cohort of 3522 Japanese American men 71 to 93 years old. Blood pressure was measured in the supine position and after 3 minutes of standing, with the use of standardized methods. Orthostatic hypotension was defined as a drop in systolic blood pressure (SBP) of Ն20 mm Hg or in diastolic blood pressure of Ն10 mm Hg. Overall prevalence of orthostatic hypotension was 6.9% and increased with age. There was a total of 473 deaths in the cohort over 4 years; of those who died, 52 had orthostatic hypotension. Four-year age-adjusted mortality rates in those with and without orthostatic hypotension were 56.6 and 38.6 per 1000 person-years, respectively. With the use of Cox proportional hazards models, after adjustment for age, smoking, diabetes mellitus, body mass index, physical activity, seated systolic blood pressure, antihypertensive medications, hematocrit, alcohol intake, and prevalent stroke, coronary heart disease and cancer, orthostatic hypotension was a significant independent predictor of 4-year all-cause mortality (relative risk 1.64, 95% CI 1.19 to 2.26). There was a significant linear association between change in systolic blood pressure from supine position to standing and 4-year mortality rates (test for linear trend, PϽ0.001), suggesting a dose-response relation. Conclusions-Orthostatic hypotension is relatively uncommon, may be a marker for physical frailty, and is a significant independent predictor of 4-year all-cause mortality in this cohort of elderly ambulatory men. (Circulation. 1998;98:2290-2295.)

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“…2); only nine studies with good or moderate quality were kept. [9,37,40,42] and an OR of 0.68 [0.51, 0.91] for subjects with a mean age over 80 years [38,39,41,44].…”

Section: Physical Activitymentioning

confidence: 99%