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Orthostatic Intolerance in Older Persons: Etiology and Countermeasures
Orthostatic challenge produced by upright posture may lead to syncope if the cardiovascular system is unable to maintain adequate brain perfusion. This review outlines orthostatic intolerance related to the aging process, long-term bedrest confinement, drugs, and disease. Aging-associated illness or...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Frontiers Media S.A.
2017
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677785/ https://www.ncbi.nlm.nih.gov/pubmed/29163185 http://dx.doi.org/10.3389/fphys.2017.00803 |
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author | Goswami, Nandu Blaber, Andrew P. Hinghofer-Szalkay, Helmut Montani, Jean-Pierre |
author_facet | Goswami, Nandu Blaber, Andrew P. Hinghofer-Szalkay, Helmut Montani, Jean-Pierre |
author_sort | Goswami, Nandu |
collection | PubMed |
description | Orthostatic challenge produced by upright posture may lead to syncope if the cardiovascular system is unable to maintain adequate brain perfusion. This review outlines orthostatic intolerance related to the aging process, long-term bedrest confinement, drugs, and disease. Aging-associated illness or injury due to falls often leads to hospitalization. Older patients spend up to 83% of hospital admission lying in bed and thus the consequences of bedrest confinement such as physiological deconditioning, functional decline, and orthostatic intolerance represent a central challenge in the care of the vulnerable older population. This review examines current scientific knowledge regarding orthostatic intolerance and how it comes about and provides a framework for understanding of (patho-) physiological concepts of cardiovascular (in-) stability in ambulatory and bedrest confined senior citizens as well as in individuals with disease conditions [e.g., orthostatic intolerance in patients with diabetes mellitus, multiple sclerosis, Parkinson's, spinal cord injury (SCI)] or those on multiple medications (polypharmacy). Understanding these aspects, along with cardio-postural interactions, is particularly important as blood pressure destabilization leading to orthostatic intolerance affects 3–4% of the general population, and in 4 out of 10 cases the exact cause remains elusive. Reviewed also are countermeasures to orthostatic intolerance such as exercise, water drinking, mental arithmetic, cognitive training, and respiration training in SCI patients. We speculate that optimally applied countermeasures such as mental challenge maintain sympathetic activity, and improve venous return, stroke volume, and consequently, blood pressure during upright standing. Finally, this paper emphasizes the importance of an active life style in old age and why early re-mobilization following bedrest confinement or bedrest is crucial in preventing orthostatic intolerance, falls and falls-related injuries in older persons. |
format | Online Article Text |
id | pubmed-5677785 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2017 |
publisher | Frontiers Media S.A. |
record_format | MEDLINE/PubMed |
spelling | pubmed-56777852017-11-21 Orthostatic Intolerance in Older Persons: Etiology and Countermeasures Goswami, Nandu Blaber, Andrew P. Hinghofer-Szalkay, Helmut Montani, Jean-Pierre Front Physiol Physiology Orthostatic challenge produced by upright posture may lead to syncope if the cardiovascular system is unable to maintain adequate brain perfusion. This review outlines orthostatic intolerance related to the aging process, long-term bedrest confinement, drugs, and disease. Aging-associated illness or injury due to falls often leads to hospitalization. Older patients spend up to 83% of hospital admission lying in bed and thus the consequences of bedrest confinement such as physiological deconditioning, functional decline, and orthostatic intolerance represent a central challenge in the care of the vulnerable older population. This review examines current scientific knowledge regarding orthostatic intolerance and how it comes about and provides a framework for understanding of (patho-) physiological concepts of cardiovascular (in-) stability in ambulatory and bedrest confined senior citizens as well as in individuals with disease conditions [e.g., orthostatic intolerance in patients with diabetes mellitus, multiple sclerosis, Parkinson's, spinal cord injury (SCI)] or those on multiple medications (polypharmacy). Understanding these aspects, along with cardio-postural interactions, is particularly important as blood pressure destabilization leading to orthostatic intolerance affects 3–4% of the general population, and in 4 out of 10 cases the exact cause remains elusive. Reviewed also are countermeasures to orthostatic intolerance such as exercise, water drinking, mental arithmetic, cognitive training, and respiration training in SCI patients. We speculate that optimally applied countermeasures such as mental challenge maintain sympathetic activity, and improve venous return, stroke volume, and consequently, blood pressure during upright standing. Finally, this paper emphasizes the importance of an active life style in old age and why early re-mobilization following bedrest confinement or bedrest is crucial in preventing orthostatic intolerance, falls and falls-related injuries in older persons. Frontiers Media S.A. 2017-11-09 /pmc/articles/PMC5677785/ /pubmed/29163185 http://dx.doi.org/10.3389/fphys.2017.00803 Text en Copyright © 2017 Goswami, Blaber, Hinghofer-Szalkay and Montani. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
spellingShingle | Physiology Goswami, Nandu Blaber, Andrew P. Hinghofer-Szalkay, Helmut Montani, Jean-Pierre Orthostatic Intolerance in Older Persons: Etiology and Countermeasures |
title | Orthostatic Intolerance in Older Persons: Etiology and Countermeasures |
title_full | Orthostatic Intolerance in Older Persons: Etiology and Countermeasures |
title_fullStr | Orthostatic Intolerance in Older Persons: Etiology and Countermeasures |
title_full_unstemmed | Orthostatic Intolerance in Older Persons: Etiology and Countermeasures |
title_short | Orthostatic Intolerance in Older Persons: Etiology and Countermeasures |
title_sort | orthostatic intolerance in older persons: etiology and countermeasures |
topic | Physiology |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5677785/ https://www.ncbi.nlm.nih.gov/pubmed/29163185 http://dx.doi.org/10.3389/fphys.2017.00803 |
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