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The relationship between orthostatic hypotension and falling in older adults

Clinical Autonomic Research volume 24, pages 3–13 (2014)Cite this article

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.

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Acknowledgments

Supported by team grants from the Canadian Institutes for Health Research (funding reference numbers AMG-100487 and TIR-103945). This work was also supported in part by a Heart and Stroke Foundation of Canada New Investigator Award (VEC).

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  1. Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada

    Brett H. Shaw & Victoria E. Claydon

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Shaw, B.H., Claydon, V.E. The relationship between orthostatic hypotension and falling in older adults. Clin Auton Res 24, 3–13 (2014). https://doi.org/10.1007/s10286-013-0219-5

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Keywords

  • Orthostatic hypotension
  • Falls
  • Older adults
  • Blood pressure monitoring
  • Orthostatic stress testing