Orthostatic Hypotension and Falling in Older Adults

When older patients fall, we try to distinguish between balance-related falls (e.g., trips or slips) and unexplained falls (i.e., those preceded by dizziness or feeling faint or by no warning symptoms). In this prospective cohort study of 529 community-dwelling older Australians (age, ≥72), researchers collected information on participants' risk factors for falling — including orthostatic hypotension — and then followed participants for 12 months. Baseline orthostatic hypotension was defined as a drop of ≥20 mm Hg in systolic blood pressure (BP) or ≥10 mm Hg in diastolic BP during the first 3 minutes of a 70° tilt test.

During follow-up, nearly half the participants fell at least once; 85% of fallers reported exclusively balance-related falls, and 15% reported at least one unexplained fall. On multivariate analysis, the only baseline variables that predicted unexplained falling (vs. balance-related or no falling) were orthostatic hypotension and depressive symptoms. Prevalence of baseline orthostatic hypotension was 39% in the unexplained-fall group versus about 20% in the balance-related and no-fall groups. Interestingly, baseline seated BP, use of cardiovascular drugs, prevalence of hypertension, and diabetes prevalence were similar in the three groups.