Skip to main content
Top
Published in: The journal of nutrition, health & aging 1/2018

01-01-2018

Orthostatic Hypotension and Associated Factors Among Home Care Clients Aged 75 Years or Older - A Population-Based Study

Authors: A. Luukkonen, Miia Tiihonen, T. Rissanen, S. Hartikainen, I. Nykänen

Published in: The journal of nutrition, health & aging | Issue 1/2018

Login to get access

Abstract

Objectives

The aim of this study was to examine orthostatic hypotension (OH) and associated factors among home care clients aged 75 years or older.

Design

Non-randomised controlled study.

Setting and participants

The study sample included 244 home care clients aged 75 years or older living in Eastern and Central Finland.

Measurements

Nurses, nutritionists and pharmacists collected clinical data including orthostatic blood pressure, depressive symptoms (15-item Geriatric Depression Scale GDS-15), nutritional status (Mini Nutritional Assessment MNA), drug use, self-rated health, daily activities (Barthel ADL Index and Lawton and Brody IADL scale) and self-rated ability to walk 400 metres. Comorbidities were based on medical records.

Results

The prevalence of OH was 35.7% (n = 87). No association between OH and the number of drugs used or causative drug use and OH was found. In univariate analysis, coronary heart disease, systolic and diastolic blood pressure in a sitting position and lower mean MNA scores were associated with a risk of OH. Multivariate analysis showed that lower mean MNA scores (OR 1.140, 95% CI: 1.014–1.283) appeared to be independently connected to a risk of OH.

Conclusion

One-third of the home clients had OH and it was associated with lower MNA scores.
Literature
1.
go back to reference American Autonomic Society and the American Academy of Neurology. 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: 1470. American Autonomic Society and the American Academy of Neurology. 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: 1470.
2.
go back to reference Rose KM, Eigenbrodt ML, Biga RL, Couper DJ, Light KC, Sharrett AR, Heiss G. Orthostatic hypotension predicts mortality in middle-aged adults: the Atherosclerosis Risk In Communities (ARIC) Study. Circulation 2006;114:630–636.CrossRefPubMed Rose KM, Eigenbrodt ML, Biga RL, Couper DJ, Light KC, Sharrett AR, Heiss G. Orthostatic hypotension predicts mortality in middle-aged adults: the Atherosclerosis Risk In Communities (ARIC) Study. Circulation 2006;114:630–636.CrossRefPubMed
3.
go back to reference Shibao C, Grijalva CG, Raj SR, Biaggioni I, Griffin MR (2007). Orthostatic hypotension-related hospitalizations in the United States. American J Med 2007;120: 975–980.CrossRef Shibao C, Grijalva CG, Raj SR, Biaggioni I, Griffin MR (2007). Orthostatic hypotension-related hospitalizations in the United States. American J Med 2007;120: 975–980.CrossRef
4.
go back to reference Robertson D. The pathophysiology and diagnosis of orthostatic hypotension. Clin Aut Res 2008;18: 2–7.CrossRef Robertson D. The pathophysiology and diagnosis of orthostatic hypotension. Clin Aut Res 2008;18: 2–7.CrossRef
5.
go back to reference Gupta V, Lipsitz L. Orthostatic hypotension in the elderly; diagnosis and treatment. Am J Med 2007;120: 841–847.CrossRefPubMed Gupta V, Lipsitz L. Orthostatic hypotension in the elderly; diagnosis and treatment. Am J Med 2007;120: 841–847.CrossRefPubMed
6.
go back to reference Feldstein, C, Weder AB. Orthostatic hypotension: A common, serious and underrecognized problem in hospitalized patients. J Am Soc Hypertens 2012;6: 27–39. doi:S1933–1711(11)00206–3 [pii]10.1016/j.jash.2011.08.008.CrossRefPubMed Feldstein, C, Weder AB. Orthostatic hypotension: A common, serious and underrecognized problem in hospitalized patients. J Am Soc Hypertens 2012;6: 27–39. doi:S1933–1711(11)00206–3 [pii]10.1016/j.jash.2011.08.008.CrossRefPubMed
7.
go back to reference Hiitola P, Enlund H, Kettunen R, Sulkava R, Hartikainen S. Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. J Hum Hypertens 2009;23:33–39.CrossRefPubMed Hiitola P, Enlund H, Kettunen R, Sulkava R, Hartikainen S. Postural changes in blood pressure and the prevalence of orthostatic hypotension among home-dwelling elderly aged 75 years or older. J Hum Hypertens 2009;23:33–39.CrossRefPubMed
8.
go back to reference Poon IO, Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 2005;30: 173–178.CrossRefPubMed Poon IO, Braun U. High prevalence of orthostatic hypotension and its correlation with potentially causative medications among elderly veterans. J Clin Pharm Ther 2005;30: 173–178.CrossRefPubMed
9.
go back to reference Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of orthostatic blood pressure change and their clinical correlates in a frail, elderly population. JAMA 1997;277: 1299–1304.CrossRefPubMed Ooi WL, Barrett S, Hossain M, Kelley-Gagnon M, Lipsitz LA. Patterns of orthostatic blood pressure change and their clinical correlates in a frail, elderly population. JAMA 1997;277: 1299–1304.CrossRefPubMed
10.
go back to reference Weiss A, Grossman E, Beloosesky Y, Grinblat J. Orthostatic hypotension in acute geriatric ward: is it a consistent finding? Arch Int Med 2002; 162: 2369–2374.CrossRef Weiss A, Grossman E, Beloosesky Y, Grinblat J. Orthostatic hypotension in acute geriatric ward: is it a consistent finding? Arch Int Med 2002; 162: 2369–2374.CrossRef
11.
go back to reference Press Y, Punchik B, Freud T. Orthostatic hypotension and drug therapy in patients at an outpatient comprehensive geriatric assessment unit. J Hypertens 2016;34: 351–358.CrossRefPubMed Press Y, Punchik B, Freud T. Orthostatic hypotension and drug therapy in patients at an outpatient comprehensive geriatric assessment unit. J Hypertens 2016;34: 351–358.CrossRefPubMed
12.
go back to reference Jansen S, Bhangu J, de Rooij S, Daams J, Kenny RA, van der Velde N. The Association of Cardiovascular Disorders and Falls: A Systematic Review. J Am Med Dir Assoc 2016;17:193–199. doi: 10.1016/j.jamda.2015.08.022.CrossRefPubMed Jansen S, Bhangu J, de Rooij S, Daams J, Kenny RA, van der Velde N. The Association of Cardiovascular Disorders and Falls: A Systematic Review. J Am Med Dir Assoc 2016;17:193–199. doi: 10.1016/j.jamda.2015.08.022.CrossRefPubMed
13.
go back to reference Ricci F, Fedorowski A, Radico F, Romanello M, Tatasciore A, Di Nicola M, Zimarino M, De Caterina R. Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. Eur Heart J 2015;36: 1609–1617.CrossRefPubMed Ricci F, Fedorowski A, Radico F, Romanello M, Tatasciore A, Di Nicola M, Zimarino M, De Caterina R. Cardiovascular morbidity and mortality related to orthostatic hypotension: a meta-analysis of prospective observational studies. Eur Heart J 2015;36: 1609–1617.CrossRefPubMed
14.
go back to reference Xin W, Lin Z, Li X. Orthostatic hypotension and the risk of congestive heart failure: a meta-analysis of prospective cohort studies. PLoS One 2013;13:e63169.CrossRef Xin W, Lin Z, Li X. Orthostatic hypotension and the risk of congestive heart failure: a meta-analysis of prospective cohort studies. PLoS One 2013;13:e63169.CrossRef
15.
go back to reference Rodrigues R, Huber M, Lamura G. (Eds). Facts and Figures on Healthy Ageing and Long-term Care Europe and North America. European Centre for Social Welfare Policy and Research. Vienna.2012. http://www.euro.centre.org/data/LTC_Final.pdf. Rodrigues R, Huber M, Lamura G. (Eds). Facts and Figures on Healthy Ageing and Long-term Care Europe and North America. European Centre for Social Welfare Policy and Research. Vienna.2012. http://​www.​euro.​centre.​org/​data/​LTC_​Final.​pdf.​
16.
go back to reference Tiihonen M, Autonen-Honkonen K, Ahonen R, Komulainen K, Suominen L, Hartikainen S, Nykänen I. NutOrMed -optimising nutrition, oral health and medication for older home care clients -study protocol. BMC Nutrition 2015;1:1–6.CrossRef Tiihonen M, Autonen-Honkonen K, Ahonen R, Komulainen K, Suominen L, Hartikainen S, Nykänen I. NutOrMed -optimising nutrition, oral health and medication for older home care clients -study protocol. BMC Nutrition 2015;1:1–6.CrossRef
17.
go back to reference The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 1996;46:1470.CrossRef The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology 1996;46:1470.CrossRef
18.
go back to reference Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J Clin Epidem 2005;58:595–602.CrossRef Groll DL, To T, Bombardier C, Wright JG. The development of a comorbidity index with physical function as the outcome. J Clin Epidem 2005;58:595–602.CrossRef
19.
go back to reference Tikkanen P, Nykänen I, Lönnroos E, Sipilä S, Sulkava R, Hartikainen S. Physical activity at age of 20-64 years and mobility and muscle strength in old age: a community-based study. J Gerontol A Biol Sci Med Sci 2012;67: 905–910.CrossRefPubMed Tikkanen P, Nykänen I, Lönnroos E, Sipilä S, Sulkava R, Hartikainen S. Physical activity at age of 20-64 years and mobility and muscle strength in old age: a community-based study. J Gerontol A Biol Sci Med Sci 2012;67: 905–910.CrossRefPubMed
20.
go back to reference Sheik J YJ: Sheik J, Yesavage J. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 1986;5: 165–172.CrossRef Sheik J YJ: Sheik J, Yesavage J. Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clin Gerontol 1986;5: 165–172.CrossRef
21.
go back to reference Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL. The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15: 116–122.CrossRefPubMed Vellas B, Guigoz Y, Garry PJ, Nourhashemi F, Bennahum D, Lauque S, Albarede JL. The mini nutritional assessment (MNA) and its use in grading the nutritional state of elderly patients. Nutrition 1999; 15: 116–122.CrossRefPubMed
22.
go back to reference Jyrkkä J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis. Drugs & Aging 2009;26: 493–503.CrossRef Jyrkkä J, Enlund H, Korhonen MJ, Sulkava R, Hartikainen S. Patterns of drug use and factors associated with polypharmacy and excessive polypharmacy in elderly persons: results of the Kuopio 75+ study: a cross-sectional analysis. Drugs & Aging 2009;26: 493–503.CrossRef
23.
go back to reference WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2013. Oslo. 2012. http://www.whocc.no/filearchive/publications/1_2013guidelines.pdf. WHO Collaborating Centre for Drug Statistics Methodology. Guidelines for ATC classification and DDD assignment 2013. Oslo. 2012. http://​www.​whocc.​no/​filearchive/​publications/​1_​2013guidelines.​pdf.​
24.
go back to reference van der Putten JJ, Hobart JC, Freeman JA, Thompson AJ. Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the Functional Independence Measure. J Neurol Neurosurg Psych 1999;66:480–484.CrossRef van der Putten JJ, Hobart JC, Freeman JA, Thompson AJ. Measuring change in disability after inpatient rehabilitation: comparison of the responsiveness of the Barthel index and the Functional Independence Measure. J Neurol Neurosurg Psych 1999;66:480–484.CrossRef
25.
go back to reference Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179–186.CrossRefPubMed Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969;9:179–186.CrossRefPubMed
26.
go back to reference Jodaitis L, Vaillant F, Snacken M, Boland B, Spinewine A, Dalleur O, Gilles C, Petrovic M, Pepersack T. Orthostatic hypotension and associated conditions in geriatric inpatients. Acta Clin Belg 2016;70:251–258.CrossRef Jodaitis L, Vaillant F, Snacken M, Boland B, Spinewine A, Dalleur O, Gilles C, Petrovic M, Pepersack T. Orthostatic hypotension and associated conditions in geriatric inpatients. Acta Clin Belg 2016;70:251–258.CrossRef
27.
go back to reference 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 Ageing 2010;39: 51–56. doi: 10.1093/ageing/afp192.CrossRefPubMed 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 Ageing 2010;39: 51–56. doi: 10.1093/ageing/afp192.CrossRefPubMed
28.
go back to reference Verwoert GC, Mattace-Raso FU, Hofman A, Heeringa J, Stricker BH, Breteler MM, Witteman JC. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc 2008;56:1816–1820. doi: 10.1111/j.1532-5415.2008.01946.x.CrossRefPubMed Verwoert GC, Mattace-Raso FU, Hofman A, Heeringa J, Stricker BH, Breteler MM, Witteman JC. Orthostatic hypotension and risk of cardiovascular disease in elderly people: the Rotterdam study. J Am Geriatr Soc 2008;56:1816–1820. doi: 10.1111/j.1532-5415.2008.01946.x.CrossRefPubMed
29.
go back to reference Annweiler C, Schott AM, Rolland Y, Beauchet O. Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women. J Int Med 2014;2276: 285–295.CrossRef Annweiler C, Schott AM, Rolland Y, Beauchet O. Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women. J Int Med 2014;2276: 285–295.CrossRef
30.
go back to reference Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson P, Melander O. Orthostatic hypotension predicts all-cause mortality and coronary events in middleaged individuals (The Malmö Preventive Project), European Heart Journal 2010;31: 85–91.CrossRefPubMed Fedorowski A, Stavenow L, Hedblad B, Berglund G, Nilsson P, Melander O. Orthostatic hypotension predicts all-cause mortality and coronary events in middleaged individuals (The Malmö Preventive Project), European Heart Journal 2010;31: 85–91.CrossRefPubMed
31.
go back to reference McCarroll KG, Robinson DJ, Coughlan A, Healy M, Kenny RA, Cunningham C. Vitamin D and orthostatic hypotension. Age Ageing 2012;41:810–813.CrossRefPubMed McCarroll KG, Robinson DJ, Coughlan A, Healy M, Kenny RA, Cunningham C. Vitamin D and orthostatic hypotension. Age Ageing 2012;41:810–813.CrossRefPubMed
32.
go back to reference Soysal P, Yay A, Isik AT. Does vitamin D deficiency increase orthostatic hypotension risk in the elderly patients? Arch Geront Geriatr 2014;59: 74–77. Soysal P, Yay A, Isik AT. Does vitamin D deficiency increase orthostatic hypotension risk in the elderly patients? Arch Geront Geriatr 2014;59: 74–77.
Metadata
Title
Orthostatic Hypotension and Associated Factors Among Home Care Clients Aged 75 Years or Older - A Population-Based Study
Authors
A. Luukkonen
Miia Tiihonen
T. Rissanen
S. Hartikainen
I. Nykänen
Publication date
01-01-2018
Publisher
Springer Paris
Published in
The journal of nutrition, health & aging / Issue 1/2018
Print ISSN: 1279-7707
Electronic ISSN: 1760-4788
DOI
https://doi.org/10.1007/s12603-017-0953-9

Other articles of this Issue 1/2018

The journal of nutrition, health & aging 1/2018 Go to the issue