Orthostatic hypotension in older patients

Kearney, Fióna; Moore, Alan; Donegan, Ciarán

doi:10.1017/s0959259808002554

Cited by 4 publications

(8 citation statements)

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“…To control for the effects of potential covariates of orthostatic intolerance, the following variables were measured: level of the head of the bed elevation, illnesses and drugs with known orthostatic effects (Mathias 2007) and age (Kearney et al 2007). Level of head of the bed was measured using a single item that required participants to select a response option that best represented the average duration they kept the head of the bed elevated during bed rest.…”

Section: Methodsmentioning

confidence: 99%

“…First, the studies were conducted predominantly with young to middle aged physically fit and healthy adults. The results may not be applicable to older adults who are already at risk for experiencing orthostatic intolerance because of advanced age (Kearney et al. 2007) and associated chronic conditions and treatments (Goldman & Ausiello 2008).…”

Section: Introductionmentioning

confidence: 99%

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The relationship between bed rest and sitting orthostatic intolerance in adults residing in chronic care facilities

Fox

Sidani²,

Brooks³

2010

J of Nursing and Healthcare

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fox mt, sidani s & brooks d (2010) Journal of Nursing and Healthcare of Chronic Illness2, 187–196 The relationship between bed rest and sitting orthostatic intolerance in adults residing in chronic care facilities Aim. To examine the relationship between orthostatic intolerance and bed rest as it was used by/with 65 adults residing in chronic care facilities. Background. The evidence on the relationship between bed rest and orthostatic intolerance has been obtained from aerospace studies conducted in highly controlled laboratory settings, and is regarded as having high internal validity. In the studies, prolonged and continuous bed rest, administered in a horizontal or negative tilt body position, had a major effect on orthostatic intolerance in young adults. However, the applicability of the findings to the conditions of the real world of practice is questionable. Methods. Participants were recruited over the period of April 2005 to August 2006. A naturalistic cohort design was used. The cohorts represented different doses of bed rest that were naturally occurring. Comparisons were made between patients who had no bed rest (comparative dose group, n = 20), two to four days (moderate dose, n = 23) and five to seven days of bed rest (high dose, n = 22) during a one‐week monitoring period. Orthostatic intolerance was measured by orthostatic vital signs and a self‐report scale. Bed rest dose was measured by the total number of days spent in bed during one week. Results. Post hoc comparisons, using Bonferroni adjustments, indicated significant differences in adjusted means on self‐reported orthostatic intolerance between the comparative and high (CI: −4·12, −0·85; p < 0·001), and the moderate and high (CI: 0·35, 3·56, p < 0·01) bed rest dose cohorts. No group differences were found on orthostatic vital signs. Conclusions. A moderate dose of bed rest with intermittent exposure to upright posture may protect against subjective orthostatic intolerance in patients who are unable to tolerate being out of bed every day. Future research may examine the effects of reducing bed rest days on orthostatic intolerance in individuals with high doses of five to seven days of bed rest.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The relationship between bed rest and sitting orthostatic intolerance in adults residing in chronic care facilities

Fox

Sidani²,

Brooks³

2010

J of Nursing and Healthcare

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“…2 The prevalence is higher amongst those with Parkinson's disease 3 and, unsurprisingly, amongst those attending a syncope clinic. 4 The aetiology and pathophysiology of OH have been comprehensively discussed in previous articles in this journal, most recently by Kearney et al (2007). 5 OH can accompany acute illness, or present more chronically in individuals who are not obviously unwell.…”

Section: Introductionmentioning

confidence: 99%

“…4 The aetiology and pathophysiology of OH have been comprehensively discussed in previous articles in this journal, most recently by Kearney et al (2007). 5 OH can accompany acute illness, or present more chronically in individuals who are not obviously unwell. The management of OH in the acute setting is to treat the underlying cause and this rarely presents a significant management problem.…”

Section: Introductionmentioning

confidence: 99%

Non-pharmacological management of orthostatic hypotension in the older patient

Ryan

Cunningham

Fan

2011

Rev. Clin. Gerontol.

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Orthostatic hypotension (OH) occurs in up to 30% of community-dwelling older people. Its presence confers a greater risk of incident co-morbid disease and all-cause mortality. As per guidelines, first-line treatment should consist of non-pharmacological therapies. Effective lifestyle modification advice includes the avoidance of rapid postural changes and large meals. Physical counter-manoeuvres, when comprehensively described, effectively abate symptom progression. Patients should drink 1.5 to 2 litres of water daily, though reports suggest only half of older people comply with this regime. Moderate salt consumption is advised, though with caution as supine hypertension often co-exists. Compression hosiery benefits older people and, contrary to popular opinion, is well tolerated. Potential, future therapies include impedance threshold devices. Older patients with OH frequently have co-morbid disease such that a pharmacological approach is ill-advised. They respond well to non-pharmacological therapies and these should form the primary therapeutic approach.

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“…The clinical combination of hypertension, especially isolated systolic hypertension, and orthostatic hypotension (OH) is an increasingly well-recognized phenomenon affecting older patients [1][2][3][4]. The essential clinical dilemma that this patient group poses for clinicians is how to provide a degree of protection against future adverse vascular events, particularly stroke, while not predisposing to syncope and falls (and therefore fractures) due to OH.…”

mentioning

confidence: 99%