Orthostatic Hypotension, Frailty, and Cognitive Impairments Among Older Adults: A Hospital-based Study
DOI:
https://doi.org/10.31661/gmj.v14i.3735Keywords:
Orthostatic Hypotension; Frailty; Cognitive Impairment; Older Adults; Outpatient Geriatric CareAbstract
Background: Orthostatic hypotension (OH) is a common condition, affecting roughly 20% of community-dwelling older adults and up to 25% of those in long-term care facilities. Its presence in older adults has been linked to heightened risks of frailty, cognitive decline, and increased fall rates, yet few studies have comprehensively examined these associations in outpatient settings. This study investigates the relationships between OH, frailty, and cognitive impairments in older adults attending an outpatient geriatric clinic. Materials and Methods: A cross-sectional study was conducted among 250 older adults (aged 60 years and above) visiting the Outpatient Geriatric Clinic at Firoozabadi Hospital. Cognitive function was evaluated using the Abbreviated Mental Test Score (AMTS) and Mini-Cog, while frailty status was determined through the Fried Frailty Index. Results: Participants had an average age of 70.72 ± 7.24 years, with ages ranging from 60 to 90. Of the total participants, 38.8% (97) were male, and 61.2% (153) were female. Average systolic blood pressure (SBP) was 132.04 ± 21.64 mmHg, and average diastolic blood pressure (DBP) was 79.43 ± 13.01 mmHg. Among participants, 38% (95) reported a history of falls, and 34% (85) were on multiple medications (polypharmacy). Notably, 33.6% (84) were diagnosed with frailty syndrome, and 29.2% (73) exhibited prefrailty. Additionally, 34.4% (86) of the participants were found to have cognitive impairments. Conclusion: The study highlights significant associations between orthostatic hypotension, frailty, and cognitive impairment among older adults. participants displaying frailty, prefrailty, and cognitive impairments, these findings underscore the need for early screening and management of orthostatic hypotension in outpatient settings. Addressing OH could play a crucial role in mitigating frailty progression, preserving cognitive function, and reducing fall risk in older adults. Future research is warranted to explore intervention strategies that may improve the quality of life and functional outcomes in this vulnerable population.
References
Saedon NIz, Pin Tan M, Frith J. The prevalence of orthostatic hypotension: a systematic review and meta-analysis. The Journals of Gerontology: Series A. 2020;75(1):117-22.
https://doi.org/10.1093/gerona/gly188
Arik F, Soysal P, Capar E et al. The association between fear of falling and orthostatic hypotension in older adults. Aging clinical and experimental research. 2021;33:3199-204.
https://doi.org/10.1007/s40520-020-01584-2
Dani M, Dirksen A, Taraborrelli P et al. Orthostatic hypotension in older people: considerations, diagnosis and management. Clinical Medicine. 2021;21(3):e275.
https://doi.org/10.7861/clinmed.2020-1044
Aydin AE, Soysal P, Isik AT. Which is preferable for orthostatic hypotension diagnosis in older adults: active standing test or head-up tilt table test? Clinical interventions in aging. 2017:207-12.
https://doi.org/10.2147/CIA.S129868
Society CCotAA, Neurology tAAo. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology. 1996;46(5):1470-.
https://doi.org/10.1212/WNL.46.5.1470
Gibbons CH, Schmidt P, Biaggioni I et al. The recommendations of a consensus panel for the screening, diagnosis, and treatment of neurogenic orthostatic hypotension and associated supine hypertension. Journal of neurology. 2017;264:1567-82.
https://doi.org/10.1007/s00415-016-8375-x
Ometto F, Stubbs B, Annweiler C et al. Hypovitaminosis D and orthostatic hypotension: a systematic review and meta-analysis. Journal of hypertension. 2016;34(6):1036-43.
https://doi.org/10.1097/HJH.0000000000000907
Jordan J, Shannon JR, Black BK et al. The pressor response to water drinking in humans: a sympathetic reflex? Circulation. 2000;101(5):504-9.
https://doi.org/10.1161/01.CIR.101.5.504
Cooper VL, Hainsworth R. Effects of dietary salt on orthostatic tolerance, blood pressure and baroreceptor sensitivity in patients with syncope. Clinical Autonomic Research. 2002;12:236-41.
https://doi.org/10.1007/s10286-002-0018-x
El-Sayed H, Hainsworth R. Salt supplement increases plasma volume and orthostatic tolerance in patients with unexplained syncope. Heart. 1996;75(2):134-40.
https://doi.org/10.1136/hrt.75.2.134
Smit AA, Halliwill JR, Low PA et al. Pathophysiological basis of orthostatic hypotension in autonomic failure. The Journal of physiology. 1999;519(1):1-10.
https://doi.org/10.1111/j.1469-7793.1999.0001o.x
Denq J-C, Opfer-Gehrking T, Giuliani M et al. Efficacy of compression of different capacitance beds in the amelioration of orthostatic hypotension. Clinical Autonomic Research. 1997;7:321-6.
https://doi.org/10.1007/BF02267725
Smit AA, Wieling W, Fujimura J et al. Use of lower abdominal compression to combat orthostatic hypotension in patients with autonomic dysfunction. Clinical Autonomic Research. 2004;14:167-75.
https://doi.org/10.1007/s10286-004-0187-x
Subbarayan S, Myint PK, Martin KR et al. Nonpharmacologic management of orthostatic hypotension in older people: a systematic review The SENATOR ONTOP series. Journal of the American Medical Directors Association. 2019;20(9):1065-73.
https://doi.org/10.1016/j.jamda.2019.03.032
Cooper VL, Hainsworth R. Head-up sleeping improves orthostatic tolerance in patients with syncope. Clinical Autonomic Research. 2008;18:318-24.
https://doi.org/10.1007/s10286-008-0494-8
Harkel AT, Van Lieshout J, Wieling W. Treatment of orthostatic hypotension with sleeping in the head-up tilt position, alone and in combination with fludrocortisone. Journal of internal medicine. 1992;232(2):139-45.
https://doi.org/10.1111/j.1365-2796.1992.tb00563.x
Ong HL, Abdin E, Seow E et al. Prevalence and associative factors of orthostatic hypotension in older adults: Results from the Well-being of the Singapore Elderly (WiSE) study. Archives of gerontology and geriatrics. 2017;72:146-52.
https://doi.org/10.1016/j.archger.2017.06.004
Campbell I, Ewing D, Clarke B. 9-Alpha-fluorohydrocortisone in the treatment of postural hypotension in diabetic autonomic neuropathy. Diabetes. 1975;24(4):381-4.
https://doi.org/10.2337/diab.24.4.381
Lahrmann H, Cortelli P, Hilz M et al. EFNS guidelines on the diagnosis and management of orthostatic hypotension. European journal of neurology. 2006;13(9):930-6.
https://doi.org/10.1111/j.1468-1331.2006.01512.x
Izcovich A, González Malla C, Manzotti M et al. Midodrine for orthostatic hypotension and recurrent reflex syncope: a systematic review. Neurology. 2014;83(13):1170-7.
https://doi.org/10.1212/WNL.0000000000000815
Fried LP, Tangen CM, Walston J et al. Frailty in older adults: evidence for a phenotype. The Journals of Gerontology Series A: Biological Sciences and Medical Sciences. 2001;56(3):M146-M57.
https://doi.org/10.1093/gerona/56.3.M146
Bu Z, Huang A, Xue M et al. Cognitive frailty as a predictor of adverse outcomes among older adults: A systematic review and meta-analysis. Brain and behavior. 2021;11(1):e01926.
https://doi.org/10.1002/brb3.1926
Hodkinson H. Evaluation of a mental test score for assessment of mental impairment in the elderly. Age and ageing. 1972;1(4):233-8.
https://doi.org/10.1093/ageing/1.4.233
Seitz DP, Chan CC, Newton HT et al. Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting. Cochrane Database of Systematic Reviews. 2018; (2):17116.
https://doi.org/10.1002/14651858.CD011415.pub2
Seitz DP, Chan CC, Newton HT et al. Mini-Cog for the diagnosis of Alzheimer's disease dementia and other dementias within a primary care setting. Cochrane Database of Systematic Reviews. 2018; (2):17116.
https://doi.org/10.1002/14651858.CD011415.pub2
Kamaruzzaman S, Watt H, Carson C, Ebrahim S. The association between orthostatic hypotension and medication use in the British Women's Heart and Health Study. Age and ageing. 2010;39(1):51-6.
https://doi.org/10.1093/ageing/afp192
Mol A, Slangen LR, Van Wezel RJ, Maier AB, Meskers CG. Orthostatic blood pressure recovery associates with physical performance, frailty and number of falls in geriatric outpatients. Journal of hypertension. 2021;39(1):101-6.
https://doi.org/10.1097/HJH.0000000000002617
Zia A, Kamaruzzaman SB, Myint PK, Tan MP. The association of antihypertensives with postural blood pressure and falls among seniors residing in the community: a case-control study. European Journal of Clinical Investigation. 2015;45(10):1069-76.
https://doi.org/10.1111/eci.12508
-Hillebrand SL, Reijnierse EM, Meskers CG, Maier AB. Orthostatic hypotension assessed by active standing is associated with worse cognition in geriatric rehabilitation inpatients, RESORT. Archives of Gerontology and Geriatrics. 2021;96:104482.
https://doi.org/10.1016/j.archger.2021.104482
-Anaraki SR, Mohammadian A, Larijani SS, Niksolat M, Rashedi V, Mesgarha MG. Frailty syndrome in women with osteoporosis, should physicians consider screening A cross-sectional study. Bone Reports. 2023;19:101722.
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