Orthostatic Hypotension and Orthostatic Intolerance Symptoms in Geriatric Rehabilitation Inpatients, RESORT

Abstract

Objectives: Orthostatic hypotension (OH) and orthostatic intolerance symptoms are common in older community-dwelling adults and are associated with reduced quality of life and detrimental health outcomes. This study aimed to determine the prevalence, co-occurrence and determinants of OH and orthostatic intolerance symptoms in geriatric rehabilitation inpatients. Design: Observational, longitudinal cohort, "REStORing the health of acutely unwell adulTs" (RESORT). Setting and Participants: Geriatric rehabilitation inpatients (n ¼ 1505) of a tertiary teaching hospital in Melbourne, Australia. Methods: OH was defined as a drop in systolic blood pressure by !20 mm Hg and/or diastolic blood pressure by !10 mm Hg within three 3 of moving from supine to a standing or sitting position. Symptoms were recorded following the 3 minutes. Determinants included sociodemographics, reason for admission, cognitive health, nutritional status, physical performance, frailty, morbidity, medication use, length of stay (LOS), and number of geriatric conditions. Independent t-tests, Mann-Whitney U tests or c 2 tests were used to analyze differences between inpatients with and without OH and symptoms.Logistic regression analyses were used to ascertain the determinants. Results: OH and orthostatic intolerance symptoms were prevalent in 19.8% (standing: 21.4%, sitting: 18.2%) and 22.6% (standing: 25.0%, sitting: 20.2%) of inpatients, respectively. Symptoms were reported by 32.8% of inpatients with OH and 20.1% without OH. Higher number of comorbidities and geriatric conditions, low functional independence, and longer LOS were determinants of OH. Female gender, higher number of morbidities and geriatric conditions, low functional independence, depression risk, poor physical performance, musculoskeletal and "other" reasons for admission, and long LOS during geriatric rehabilitation were determinants of symptoms. Conclusions and Implications: OH and orthostatic intolerance symptoms occur in one-fifth of geriatric rehabilitation inpatients, however, the co-occurrence is low and determinants differ. Poorer health in patients with orthostatic intolerance symptoms highlights the need to assess symptoms in clinical practice, independent of an OH diagnosis.

Predictive Value of Ultrasound-Measured Quadriceps Depth and Frailty Status for Hypotension in Older Patients Undergoing Reverse Total Shoulder Arthroplasty in the Beach Chair Position under General Anesthesia

“…Hypotension in the BCP and orthostatic hypotension may share a similar triggering mechanism and engage the corresponding efferent reflex pathway [ 14 ]. Additionally, orthostatic hypotension has been reported to be poorly tolerated in frail patients [ 18 , 19 , 20 ]. Thus, several pathologies associated with frailty may contribute to the occurrence of hypotension in BCP [ 21 , 22 ].…”

The prevalence and risk factors of orthostatic hypotension with cardiovascular diseases: An observational study

“…If the patient has symptoms and does not have OH, orthostatic blood pressure needs to be measured several times and the standing time should be extended appropriately to improve the detection rate of OH. Research had found that one-fth of elderly rehabilitation inpatients had OH and discomfort after standing, and patients with discomfort had poor health [43]. It is suggested that we should focus on patients with uncomfortable symptoms after standing, and take timely preventive and management measures to delay the development of the disease and avoid the occurrence of serious adverse events.…”