Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents

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...

Full description

Bibliographic Details
Main Authors: Brett H. Shaw, Dave Borrel, Kimiya Sabbaghan, Colton Kum, Yijian Yang, Stephen N. Robinovitch, Victoria E. Claydon
Format: Article
Language:English
Published: BMC 2019-03-01
Series:BMC Geriatrics
Subjects:
Online Access:http://link.springer.com/article/10.1186/s12877-019-1082-6
id doaj-f9ea4e78ad4343e0abee4eb7853eef14
record_format Article
spelling doaj-f9ea4e78ad4343e0abee4eb7853eef142020-11-25T03:50:57ZengBMCBMC Geriatrics1471-23182019-03-0119111410.1186/s12877-019-1082-6Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residentsBrett H. Shaw0Dave Borrel1Kimiya Sabbaghan2Colton Kum3Yijian Yang4Stephen N. Robinovitch5Victoria E. Claydon6Department of Biomedical Physiology and Kinesiology, Simon Fraser UniversityDepartment of Biomedical Physiology and Kinesiology, Simon Fraser UniversityDepartment of Biomedical Physiology and Kinesiology, Simon Fraser UniversityDepartment of Biomedical Physiology and Kinesiology, Simon Fraser UniversityDepartment of Biomedical Physiology and Kinesiology, Simon Fraser UniversityDepartment of Biomedical Physiology and Kinesiology, Simon Fraser UniversityDepartment of Biomedical Physiology and Kinesiology, Simon Fraser UniversityAbstract 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.http://link.springer.com/article/10.1186/s12877-019-1082-6FrailtyOrthostatic hypotensionFallingOlder adults
collection DOAJ
language English
format Article
sources DOAJ
author Brett H. Shaw
Dave Borrel
Kimiya Sabbaghan
Colton Kum
Yijian Yang
Stephen N. Robinovitch
Victoria E. Claydon
spellingShingle Brett H. Shaw
Dave Borrel
Kimiya Sabbaghan
Colton Kum
Yijian Yang
Stephen N. Robinovitch
Victoria E. Claydon
Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents
BMC Geriatrics
Frailty
Orthostatic hypotension
Falling
Older adults
author_facet Brett H. Shaw
Dave Borrel
Kimiya Sabbaghan
Colton Kum
Yijian Yang
Stephen N. Robinovitch
Victoria E. Claydon
author_sort Brett H. Shaw
title Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents
title_short Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents
title_full Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents
title_fullStr Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents
title_full_unstemmed Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents
title_sort relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents
publisher BMC
series BMC Geriatrics
issn 1471-2318
publishDate 2019-03-01
description 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.
topic Frailty
Orthostatic hypotension
Falling
Older adults
url http://link.springer.com/article/10.1186/s12877-019-1082-6
work_keys_str_mv AT bretthshaw relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT daveborrel relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT kimiyasabbaghan relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT coltonkum relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT yijianyang relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT stephennrobinovitch relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT victoriaeclaydon relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
_version_ 1724489574226329600