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Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents.
BMC Geriatr. 2019 03 13; 19(1):80.BG

Abstract

BACKGROUND

Orthostatic hypotension (OH; profound falls in blood pressure when upright) is a common deficit that increases in incidence with age, and may be associated with falling risk. Deficit accumulation results in frailty, regarded as enhanced vulnerability to adverse outcomes. We aimed to evaluate the relationships between OH, frailty, falling and mortality in elderly care home residents.

METHODS

From the Minimum Data Set (MDS) document, a frailty index (FI-MDS) was generated from a list of 58 deficits, ranging from 0 (no deficits) to 1.0 (58 deficits). OH was evaluated from beat-to-beat blood pressure and heart rate (finger plethysmography) collected during a 15-min supine-seated orthostatic stress test. Retrospective and prospective falling rates (falls/year) were extracted from facility falls incident reports. All-cause 3-year mortality was determined. Data are reported as mean ± standard error.

RESULTS

Data were obtained from 116 older adults (aged 84.2 ± 0.9 years; 44% males) living in two long term care facilities. The mean FI-MDS was 0.36 ± 0.01; FI-MDS was correlated with age (r = 0.277; p = 0.003). Those who were frail (FI ≥ 0.27) had larger Initial (- 17.8 ± 4.2 vs - 6.1 ± 3.3 mmHg, p = 0.03) and Consensus (- 22.7 ± 4.3 vs - 11.5 ± 3.3 mmHg, p = 0.04) orthostatic reductions in systolic arterial pressure. Frail individuals had higher prospective and retrospective falling rates and higher 3-year mortality. Receiver operating characteristic curves evaluated the ability of FI-MDS alone to predict prospective falls (sensitivity 72%, specificity 36%), Consensus OH (sensitivity 68%, specificity 60%) and 3-year mortality (sensitivity 77%, specificity 49%). Kaplan Meier survival analyses showed significantly higher 3-year mortality in those who were frail compared to the non-frail (p = 0.005).

CONCLUSIONS

Frailty can be captured using a frailty index based on MDS data in elderly individuals living in long term care, and is related to susceptibility to orthostatic hypotension, falling risk and 3-year mortality. Use of the MDS to generate a frailty index may represent a simple and convenient risk assessment tool for older adults living in long term care. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this risk.

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Authors+Show Affiliations

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada.

Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, V5A 1S6, Canada. victoria_claydon@sfu.ca.

MeSH

Accidental FallsAgedAged, 80 and overBlood PressureFemaleFrail ElderlyFrailtyGeriatric AssessmentHeart RateHomes for the AgedHumansHypotension, OrthostaticLong-Term CareMaleProspective StudiesRetrospective StudiesRisk Assessment

Pub Type(s)

Journal Article

Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30866845

Citation

Shaw, Brett H., et al. "Relationships Between Orthostatic Hypotension, Frailty, Falling and Mortality in Elderly Care Home Residents." BMC Geriatrics, vol. 19, no. 1, 2019, p. 80.

Shaw BH, Borrel D, Sabbaghan K, et al. Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents. BMC Geriatr. 2019;19(1):80.

Shaw, B. H., Borrel, D., Sabbaghan, K., Kum, C., Yang, Y., Robinovitch, S. N., & Claydon, V. E. (2019). Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents. BMC Geriatrics, 19(1), 80. https://doi.org/10.1186/s12877-019-1082-6

Shaw BH, et al. Relationships Between Orthostatic Hypotension, Frailty, Falling and Mortality in Elderly Care Home Residents. BMC Geriatr. 2019 03 13;19(1):80. PubMed PMID: 30866845.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents. AU - Shaw,Brett H, AU - Borrel,Dave, AU - Sabbaghan,Kimiya, AU - Kum,Colton, AU - Yang,Yijian, AU - Robinovitch,Stephen N, AU - Claydon,Victoria E, Y1 - 2019/03/13/ PY - 2018/10/05/received PY - 2019/02/21/accepted PY - 2019/3/15/entrez PY - 2019/3/15/pubmed PY - 2020/1/21/medline KW - Falling KW - Frailty KW - Older adults KW - Orthostatic hypotension SP - 80 EP - 80 JF - BMC geriatrics JO - BMC Geriatr VL - 19 IS - 1 N2 - BACKGROUND: Orthostatic hypotension (OH; profound falls in blood pressure when upright) is a common deficit that increases in incidence with age, and may be associated with falling risk. Deficit accumulation results in frailty, regarded as enhanced vulnerability to adverse outcomes. We aimed to evaluate the relationships between OH, frailty, falling and mortality in elderly care home residents. METHODS: From the Minimum Data Set (MDS) document, a frailty index (FI-MDS) was generated from a list of 58 deficits, ranging from 0 (no deficits) to 1.0 (58 deficits). OH was evaluated from beat-to-beat blood pressure and heart rate (finger plethysmography) collected during a 15-min supine-seated orthostatic stress test. Retrospective and prospective falling rates (falls/year) were extracted from facility falls incident reports. All-cause 3-year mortality was determined. Data are reported as mean ± standard error. RESULTS: Data were obtained from 116 older adults (aged 84.2 ± 0.9 years; 44% males) living in two long term care facilities. The mean FI-MDS was 0.36 ± 0.01; FI-MDS was correlated with age (r = 0.277; p = 0.003). Those who were frail (FI ≥ 0.27) had larger Initial (- 17.8 ± 4.2 vs - 6.1 ± 3.3 mmHg, p = 0.03) and Consensus (- 22.7 ± 4.3 vs - 11.5 ± 3.3 mmHg, p = 0.04) orthostatic reductions in systolic arterial pressure. Frail individuals had higher prospective and retrospective falling rates and higher 3-year mortality. Receiver operating characteristic curves evaluated the ability of FI-MDS alone to predict prospective falls (sensitivity 72%, specificity 36%), Consensus OH (sensitivity 68%, specificity 60%) and 3-year mortality (sensitivity 77%, specificity 49%). Kaplan Meier survival analyses showed significantly higher 3-year mortality in those who were frail compared to the non-frail (p = 0.005). CONCLUSIONS: Frailty can be captured using a frailty index based on MDS data in elderly individuals living in long term care, and is related to susceptibility to orthostatic hypotension, falling risk and 3-year mortality. Use of the MDS to generate a frailty index may represent a simple and convenient risk assessment tool for older adults living in long term care. Older adults who are both frail and have impaired orthostatic blood pressure control have a particularly high risk of falling and should receive tailored management to mitigate this risk. SN - 1471-2318 UR - https://www.unboundmedicine.com/medline/citation/30866845/Relationships_between_orthostatic_hypotension_frailty_falling_and_mortality_in_elderly_care_home_residents_ L2 - https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1082-6 DB - PRIME DP - Unbound Medicine ER -