The relationship between orthostatic hypotension and falling in older adults

Abstract

Falls are devastating events and are the largest contributor towards injury-related hospitalization of older adults. Orthostatic hypotension (OH) represents an intrinsic risk factor for falls in older adults. OH refers to a significant decrease in blood pressure upon assuming an upright posture. Declines in blood pressure can reduce cerebral perfusion; this can impair consciousness, lead to dizziness, and increase the likelihood of a fall. Although theoretical mechanisms linking OH and falls exist, the magnitude of the association remains poorly characterized, possibly because of methodological differences between previous studies. The use of non-invasive beat-to-beat blood pressure monitoring has altered the way in which OH is now defined, and represents a substantial improvement for detecting OH that was previously unavailable in many studies. Additionally, there is a lack of consistency and standardization of orthostatic assessments and analysis techniques for interpreting blood pressure data. This review explores the previous literature examining the relationship between OH and falls. We highlight the impact of broadening the timing, degree, and overall duration of blood pressure measurements on the detection of OH. We discuss the types of orthostatic stress assessments currently used to evaluate OH and the various techniques capable of measuring these often transient blood pressure changes. Overall, we identify future solutions that may better clarify the relationship between OH and falling risk in order to gain a more precise understanding of potential mechanisms for falls in older adults.

Conceptual definitions of indicators for the nursing outcome "Knowledge: Fall Prevention"

“…In the conceptualization of the indicator (182815) Blood pressure changes that increase risk for falls, besides the hypertension, already indicated as a disease related to the risk for fall, orthostatic hypotension was the main predictive condition of fall referenced in the studies, a common event in postoperative hospitalized patients due to hemodynamic changes (2,23,30) . Strategies to reduce this occurrence include: getting up slowly from a sitting or lying position, raising the headboard to 30°, sitting on the bed with feet on the floor before leaving the bed (21,23,30) .…”

“…Strategies to reduce this occurrence include: getting up slowly from a sitting or lying position, raising the headboard to 30°, sitting on the bed with feet on the floor before leaving the bed (21,23,30) . It is critical that patients are aware of these measures to reduce episodes of orthostatic hypotension during their hospitalization.…”

“…Indicator (182815) Blood pressure changes that increase risk for falls Studies indicate that the main change in blood pressure that increases risk for falls is orthostatic hypotension, a frequent event in hospitalized patients, which occurs when there is a significant decrease in blood pressure, when assuming an upright posture (21,23,30) . However, hypertension, previously mentioned, is also associated with the risk for falls (25) .…”

The association between orthostatic hypotension, falling and successful rehabilitation in a nursing home population

“…Presence of OH increases the risk of cardiovascular disease and all-cause mortality in elderly people (Masaki et al, 1998;Rose et al, 2000;Verwoert et al, 2008;Xin, Lin, & Mi, 2014). Furthermore, morbidity associated with OH is not limited to cardiovascular disease; some studies strongly suggest OH to be associated with falls, which in turn can lead to serious morbidity (Benvenuto & Krakoff, 2011;Scheffer et al, 2013;Shaw & Claydon, 2014).…”

Standing Up Slowly Antagonises Initial Blood Pressure Decrease in Older Adults with Orthostatic Hypotension

“…OH prevails in older adults, especially in those with one or more chronic diseases [2,3] . Older adults with OH are at risk of falling while standing up [4] , which is associated with increased morbidity, high health-care costs and loss of independence [5] . Especially initial OH (iOH), defined as a BP decrease within 15 s after standing up of 40 mm Hg SBP and/or 20 mm Hg DBP, is associated with falls [6] .…”