Abstract
Background
Orthostatic hypotension (OH) has high prevalence in frail older adults. However, its
effect on mortality, disability, and hospitalization in frail older adults is poorly
investigated. Thus, we assessed the relationship between the prevalence of OH and
its effect on mortality, disability, and hospitalization in noninstitutionalized older
adults stratified by frailty degree.
Methods
Prospective, observational study of 510 older participants (≥65 years of age) consecutively
admitted to a geriatric evaluation unit to perform a geriatric comprehensive assessment.
Measurements
Clinical frailty was assessed using the Italian frailty index (40 items). Systolic
blood pressure (mm Hg), diastolic blood pressure (mm Hg), and heart rate (bpm) were
evaluated in clinostatic position and after 1, 3, and 5 minutes of orthostatic position.
OH was defined with a decrease of 20 mm Hg in systolic blood pressure and/or a decrease
of 10 mm Hg in diastolic blood pressure.
Results
OH prevalence was 22%, and it increased from 9.0% to 66.0% according to frailty degree
(P for trend <.001). When stratified by frailty degree, mortality, disability, and hospitalization
increased from 1.0% to 24.5%, from 39.0% to 77.0% and from 14.0% to 32.0% in the absence,
and from 0.0% to 35.5%, from 42.0% to 95.5% and from 19.0% to 65.5% in the presence
of OH, respectively (P < .01 vs absence of OH). Multivariate analysis showed that the Italian frailty index
is more predictive of mortality, disability, and hospitalization in the presence than
in the absence of OH.
Conclusions
OH is a common condition in frail older adults, and it is strongly associated with
mortality, disability, and hospitalization in the highest frailty degree. Thus, OH
may represent a new marker of clinical frailty.
Keywords
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Article info
Publication history
Published online: June 22, 2018
Footnotes
The authors declare no conflicts of interest.
Identification
Copyright
© 2018 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
