Cargando…

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

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 eval...

Descripción completa

Detalles Bibliográficos
Autores principales: Shaw, Brett H., Borrel, Dave, Sabbaghan, Kimiya, Kum, Colton, Yang, Yijian, Robinovitch, Stephen N., Claydon, Victoria E.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415493/
https://www.ncbi.nlm.nih.gov/pubmed/30866845
http://dx.doi.org/10.1186/s12877-019-1082-6
_version_ 1783403200403996672
author Shaw, Brett H.
Borrel, Dave
Sabbaghan, Kimiya
Kum, Colton
Yang, Yijian
Robinovitch, Stephen N.
Claydon, Victoria E.
author_facet Shaw, Brett H.
Borrel, Dave
Sabbaghan, Kimiya
Kum, Colton
Yang, Yijian
Robinovitch, Stephen N.
Claydon, Victoria E.
author_sort Shaw, Brett H.
collection PubMed
description 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12877-019-1082-6) contains supplementary material, which is available to authorized users.
format Online
Article
Text
id pubmed-6415493
institution National Center for Biotechnology Information
language English
publishDate 2019
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-64154932019-03-25 Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents Shaw, Brett H. Borrel, Dave Sabbaghan, Kimiya Kum, Colton Yang, Yijian Robinovitch, Stephen N. Claydon, Victoria E. BMC Geriatr Research Article 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. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s12877-019-1082-6) contains supplementary material, which is available to authorized users. BioMed Central 2019-03-13 /pmc/articles/PMC6415493/ /pubmed/30866845 http://dx.doi.org/10.1186/s12877-019-1082-6 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Shaw, Brett H.
Borrel, Dave
Sabbaghan, Kimiya
Kum, Colton
Yang, Yijian
Robinovitch, Stephen N.
Claydon, Victoria E.
Relationships between orthostatic hypotension, frailty, falling and mortality in elderly care home residents
title 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_short 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
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6415493/
https://www.ncbi.nlm.nih.gov/pubmed/30866845
http://dx.doi.org/10.1186/s12877-019-1082-6
work_keys_str_mv AT shawbretth relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT borreldave relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT sabbaghankimiya relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT kumcolton relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT yangyijian relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT robinovitchstephenn relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents
AT claydonvictoriae relationshipsbetweenorthostatichypotensionfrailtyfallingandmortalityinelderlycarehomeresidents