The association between orthostatic hypotension and recurrent falls in nursing home residents

Abstract

Purpose: Orthostatic hypotension is common among the elderly, but its relation to falls is not certain. We determined whether orthostatic hypotension, including its timing and frequency, was associated with falls in elderly nursing home residents.

Subjects and methods: We conducted a prospective study of 844 elderly (60 years of age and older), long-stay residents at 40 facilities that were part of a multistate nursing home chain. All subjects were able to maintain weight-bearing for at least 1 minute. Orthostatic hypotension was defined as a 20 mm Hg or greater decrease in systolic blood pressure from supine to standing, as measured after 1 or 3 minutes of standing on four occasions (before or after breakfast, or before or after lunch). The outcome was any subsequent fall during a mean of 1.2 years of follow-up.

Results: Orthostatic hypotension was present (at least on one measurement) in 50% of the subjects but was not associated with subsequent falls. However, among subjects with a history of previous falls in the past 6 months, those with orthostatic hypotension had an increased risk of recurrent falls [adjusted relative risk (RR) = 2.1; 95% confidence interval (CI), 1.4 to 3.1 ]. The risk of subsequent falls was greatest in previous fallers who had orthostatic hypotension at two or more measurements (RR = 2.6; 95% CI, 1.7 to 4.6). The association between orthostatic hypotension and recurrent falls was independent of measured demographic or clinical risk factors for falls. The timing of orthostatic hypotension (before or after meals) did not affect the risk of falls.

Conclusions: Orthostatic hypotension is an independent risk factor for recurrent falls among elderly nursing home residents. Although the benefit of treating orthostatic hypotension will require further study, it may be prudent to identify high-risk residents and institute precautionary measures.