Advertisement

The journal of nutrition, health & aging

, Volume 23, Issue 4, pp 318–322 | Cite as

Association Between Orthostatic Hypotension and Frailty in Hospitalized Older Patients: A Geriatric Syndrome More Than a Cardiovascular Condition

  • L. Chen
  • Y. Xu
  • Xujiao ChenEmail author
  • Wei-Ju LeeEmail author
  • L.-K. Chen
Article

Abstract

Objectives

To explore the association between orthostatic hypotension (OH) and frailty for hospitalized older patients and their vulnerable subgroups.

Design

A prospective, observational cross-sectional study.

Participants

693 older patients admitted to a geriatric evaluation and management unit.

Measurements

Barthel Index, Lawton’s instrumental activities of daily living, clinical frailty scale, mini-mental state examination, geriatric depression scale, mini-nutritional assessment, and polypharmacy.

Results

Overall, the prevalence of OH and frailty was 26% and 36%, respectively. Subjects with OH were older, thinner, more commonly to have weakness, slowness, poorer physical function and higher levels of frailty. The prevalence of OH was substantially increased as higher levels of CFS (p for trend <0.001). Multivariate logistic regression showed significant association between OH and frailty (OR: 1.8, 95% CI: 1.2-2.7), but the association attenuated after adjustment for physical function. (OR: 1.4, 95% CI: 0.7-2.6). Nevertheless, associations between OH and frailty remained significant among vulnerable subgroups like women, subjects having weakness, slowness, poor cognitive function, polypharmacy or any IADL limitation.

Conclusions

OH in hospitalized older patients was associated with frailty and multiple complex care needs, especially in the vulnerable subgroups. Further study is needed to clarify the roles of OH in clinical practice.

Key words

Frailty older adults orthostatic hypotension comprehensive geriatric assessment 

References

  1. 1.
    Feldstein C, Weder AB. Orthostatic hypotension: a common, serious and underrecognized problem in hospitalized patients. Journal of the American Society of Hypertension. 2012;6(1):27–39.CrossRefGoogle Scholar
  2. 2.
    Freeman R, Wieling W, Axelrod FB, Benditt DG, Benarroch E, Biaggioni I, et al. Consensus statement on the definition of orthostatic hypotension, neurally mediated syncope and the postural tachycardia syndrome. Auton Neurosci. 2011;161(1-2):46–8.CrossRefGoogle Scholar
  3. 3.
    Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Neurology. 1996;46(5):1470.Google Scholar
  4. 4.
    Wieling W, Schatz IJ. The consensus statement on the definition of orthostatic hypotension: a revisit after 13 years. J Hypertens. 2009;27(5):935–8.CrossRefGoogle Scholar
  5. 5.
    Townsend RR, Chang TI, Cohen DL, Cushman WC, Evans GW, Glasser SP, et al. Orthostatic changes in systolic blood pressure among SPRINT participants at baseline. J Am Soc Hypertens. 2016;10(11):847–56.CrossRefGoogle Scholar
  6. 6.
    Finucane C, O’Connell MD, Fan CW, Savva GM, Soraghan CJ, Nolan H, et al. Agerelated normative changes in phasic orthostatic blood pressure in a large population study: findings from The Irish Longitudinal Study on Ageing (TILDA). Circulation. 2014;130(20):1780–9.CrossRefGoogle Scholar
  7. 7.
    O’Connell MD, Savva GM, Fan CW, Kenny RA. Orthostatic hypotension, orthostatic intolerance and frailty: The Irish Longitudinal Study on Aging-TILDA. Arch Gerontol Geriatr. 2015;60(3):507–13.CrossRefGoogle Scholar
  8. 8.
    Clark CE, Thomas D, Warren FC, Llewellyn DJ, Ferrucci L, Campbell JL. Detecting Risk Of Postural hypotension (DROP): derivation and validation of a prediction score for primary care. BMJ Open. 2018;8(4):e020740.CrossRefGoogle Scholar
  9. 9.
    Liguori I, Russo G, Coscia V, Aran L, Bulli G, Curcio F, et al. Orthostatic Hypotension in the Elderly: A Marker of Clinical Frailty? J Am Med Dir Assoc. 2018. doi: 10.1016/j.jamda.2018.04.018. [in press]Google Scholar
  10. 10.
    Ricci F, De Caterina R, Fedorowski A. Orthostatic Hypotension: Epidemiology, Prognosis, and Treatment. J Am Coll Cardiol. 2015;66(7):848–60.CrossRefGoogle Scholar
  11. 11.
    Hartog LC, Schrijnders D, Landman GWD, Groenier K, Kleefstra N, Bilo HJG, et al. Is orthostatic hypotension related to falling? A meta-analysis of individual patient data of prospective observational studies. Age Ageing. 2017;46(4):568–75.CrossRefGoogle Scholar
  12. 12.
    Rockwood MR, Howlett SE, Rockwood K. Orthostatic hypotension (OH) and mortality in relation to age, blood pressure and frailty. Arch Gerontol Geriatr. 2012;54(3):e255-60.CrossRefGoogle Scholar
  13. 13.
    Curreri C, Giantin V, Veronese N, Trevisan C, Sartori L, Musacchio E, et al. Orthostatic Changes in Blood Pressure and Cognitive Status in the Elderly: The Progetto Veneto Anziani Study. Hypertension. 2016;68(2):427–35.CrossRefGoogle Scholar
  14. 14.
    Angelousi A, Girerd N, Benetos A, Frimat L, Gautier S, Weryha G, et al. Association between orthostatic hypotension and cardiovascular risk, cerebrovascular risk, cognitive decline and falls as well as overall mortality: a systematic review and metaanalysis. J Hypertens. 2014;32(8):1562–71; discussion 71.CrossRefGoogle Scholar
  15. 15.
    Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56(3):M146-56.CrossRefGoogle Scholar
  16. 16.
    Clegg A, Young J, Iliffe S, Rikkert MO, Rockwood K. Frailty in elderly people. Lancet. 2013;381(9868):752–62.CrossRefGoogle Scholar
  17. 17.
    Liu LK, Lee WJ, Chen LY, Hwang AC, Lin MH, Peng LN, et al. Association between Frailty, Osteoporosis, Falls and Hip Fractures among Community-Dwelling People Aged 50 Years and Older in Taiwan: Results from I-Lan Longitudinal Aging Study. PLoS One. 2015;10(9):e0136968.CrossRefGoogle Scholar
  18. 18.
    Lee WJ, Chen LK, Tang GJ, Lan TY. The impact of influenza vaccination on hospitalizations and mortality among frail older people. J Am Med Dir Assoc. 2014;15(4):256–60.CrossRefGoogle Scholar
  19. 19.
    Rockwood K, Song X, MacKnight C, Bergman H, Hogan DB, McDowell I, et al. A global clinical measure of fitness and frailty in elderly people. CMAJ. 2005;173(5):489–95.CrossRefGoogle Scholar
  20. 20.
    Romero-Ortuno R, Cogan L, O’Shea D, Lawlor BA, Kenny RA. Orthostatic haemodynamics may be impaired in frailty. Age Ageing. 2011;40(5):576–83.CrossRefGoogle Scholar
  21. 21.
    von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP, et al. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Lancet. 2007;370(9596):1453–7.CrossRefGoogle Scholar
  22. 22.
    Lee WJ, Peng LN, Cheng YY, Liu CY, Chen LK, Yu HC. Effectiveness of short-term interdisciplinary intervention on postacute patients in Taiwan. J Am Med Dir Assoc. 2011;12(1):29–32.CrossRefGoogle Scholar
  23. 23.
    Mahoney FI, Barthel DW. Functional Evaluation: The Barthel Index. Md State Med J. 1965;14:61–5.Google Scholar
  24. 24.
    Graf C, Hartford Institute for Geriatric N. The Lawton instrumental activities of daily living (IADL) scale. Medsurg Nurs. 2008;17(5):343–4.Google Scholar
  25. 25.
    Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12(3):189–98.Google Scholar
  26. 26.
    Chan AC. Clinical validation of the Geriatric Depression Scale (GDS): Chinese version. J Aging Health. 1996;8(2):238–53.CrossRefGoogle Scholar
  27. 27.
    Guigoz Y, Lauque S, Vellas BJ. Identifying the elderly at risk for malnutrition. The Mini Nutritional Assessment. Clin Geriatr Med. 2002;18(4):737–57.CrossRefGoogle Scholar
  28. 28.
    Huang L, Zhang SW, Wu SL, Ma L, Deng XH. The Chinese version of ICIQ: a useful tool in clinical practice and research on urinary incontinence. Neurourol Urodyn. 2008;27(6):522–4.CrossRefGoogle Scholar
  29. 29.
    Steinman MA, Landefeld CS, Rosenthal GE, Berthenthal D, Sen S, Kaboli PJ. Polypharmacy and prescribing quality in older people. J Am Geriatr Soc. 2006;54(10):1516–23.CrossRefGoogle Scholar
  30. 30.
    Huang CY, Hwang AC, Liu LK, Lee WJ, Chen LY, Peng LN, et al. Association of Dynapenia, Sarcopenia, and Cognitive Impairment Among Community-Dwelling Older Taiwanese. Rejuvenation Res. 2016;19(1):71–8.CrossRefGoogle Scholar
  31. 31.
    Chen LK, Liu LK, Woo J, Assantachai P, Auyeung TW, Bahyah KS, et al. Sarcopenia in Asia: consensus report of the Asian Working Group for Sarcopenia. J Am Med Dir Assoc. 2014;15(2):95–101.CrossRefGoogle Scholar
  32. 32.
    Torres RV, Elias MF, Crichton GE, Dore GA, Davey A. Systolic orthostatic hypotension is related to lowered cognitive function: Findings from the Maine-Syracuse Longitudinal Study. J Clin Hypertens (Greenwich). 2017;19(12):1357–65.CrossRefGoogle Scholar
  33. 33.
    Inouye SK, Studenski S, Tinetti ME, Kuchel GA. Geriatric syndromes: clinical, research, and policy implications of a core geriatric concept. J Am Geriatr Soc. 2007;55(5):780–91.CrossRefGoogle Scholar
  34. 34.
    Swift CG, Iliffe S. Assessment and prevention of falls in older people—concise guidance. Clin Med (Lond). 2014;14(6):658–62.CrossRefGoogle Scholar
  35. 35.
    Hypertension EETFftMoA. 2013 Practice guidelines for the management of arterial hypertension of the European Society of Hypertension (ESH) and the European Society of Cardiology (ESC): ESH/ESC Task Force for the Management of Arterial Hypertension. J Hypertens. 2013;31(10):1925-38.Google Scholar
  36. 36.
    Benvenuto LJ, Krakoff LR. Morbidity and mortality of orthostatic hypotension: implications for management of cardiovascular disease. Am J Hypertens. 2011;24(2):135–44.CrossRefGoogle Scholar
  37. 37.
    Searle SD, Mitnitski A, Gahbauer EA, Gill TM, Rockwood K. A standard procedure for creating a frailty index. BMC Geriatr. 2008;8:24.CrossRefGoogle Scholar
  38. 38.
    Chong E, Ho E, Baldevarona-Llego J, Chan M, Wu L, Tay L. Frailty and Risk of Adverse Outcomes in Hospitalized Older Adults: A Comparison of Different Frailty Measures. J Am Med Dir Assoc. 2017;18(7):638 e7-e11.CrossRefGoogle Scholar
  39. 39.
    National Health Insurance Administration,Taiwan 2017;Pages. Accessed at National Health Insurance Administration at https://www.nhi.gov.tw/Content_List. aspx?n=5A0BB383D955741C&topn=D39E2B72B0BDFA15 on Jul 17 2018.Google Scholar
  40. 40.
    Huang H, Zheng T, Liu F, Wu Z, Liang H, Wang S. Orthostatic Hypotension Predicts Cognitive Impairment in the Elderly: Findings from a Cohort Study. Front Neurol. 2017;8:121.Google Scholar
  41. 41.
    Wu YH, Liu LK, Chen WT, Lee WJ, Peng LN, Wang PN, et al. Cognitive Function in Individuals With Physical Frailty but Without Dementia or Cognitive Complaints: Results From the I-Lan Longitudinal Aging Study. J Am Med Dir Assoc. 2015;16(10):899 e9-16.CrossRefGoogle Scholar
  42. 42.
    Kotagal V, Lineback C, Bohnen NI, Albin RL, Investigators C-PPSG. Orthostatic hypotension predicts motor decline in early Parkinson disease. Parkinsonism Relat Disord. 2016;32:127–9.CrossRefGoogle Scholar

Copyright information

© Serdi and Springer-Verlag International SAS, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of NursingZhejiang HospitalHangzhou, Zhejiang ProvincePeople’s Republic of China
  2. 2.Department of GeriatricsZhejiang HospitalHangzhou, Zhejiang ProvincePeople’s Republic of China
  3. 3.Aging and Health Research CenterNational Yang Ming UniversityTaipeiTaiwan
  4. 4.Department of Geriatric Medecine, School of MedicineNational Yang-Ming UniversityTaipei CityTaiwan
  5. 5.Department of Family MedicineTaipei Veterans General Hospital YuanShan Branch, Yi-Lan CountyTaipeiTaiwan
  6. 6.Center for Geriatrics and GerontologyTaipei Veterans General HospitalTaipeiTaiwan

Personalised recommendations