A community-based cross-sectional survey of orthostatic hypotension among elderly from south India

BACKGROUND: Orthostatic hypotension (OH) increases the risk of falls and associated morbidity and mortality in elderly. Hence, determining the prevalence of OH and its associated factors is important, especially in understudied LMIC settings. METHODS: A community-based cross-sectional study was conducted among randomly selected 240 community-dwelling elderly from Thiruvananthapuram, Kerala. The OH symptoms were assessed by standard clinical measurements and frailty was assessed by modified Fried frailty phenotype. Logistic regression analysis was conducted to assess the factors associated with OH. RESULTS: The prevalence of OH and frailty among participants was 9.6 and 29.2 percent respectively. In the first minute, OH was associated with increased odds of falls (OR = 1.97 [95%CI = 1.05, 3.72]). Increase in number of co-morbidities (OR(adj) = 1.82 [95%CI = 1.36, 2.48]), number of medicines used (OR(adj) = 1.73 [95%CI = 1.28, 2.34]), and orthostatic intolerance (OR(adj) = 3.67 [95%CI = 1.13, 11.94]) increased the odds of having OH. Elderly with diabetes (OR(adj) = 4.81 [95%CI = 1.57, 14.77]), hypertension (OR(adj) = 4.97 [95%CI = 1.01, 24.46]) and cognitive impairment (OR(adj) = 5.01 [95%CI = 1.40, 18.51]) were at a higher odds of having OH. CONCLUSIONS: OH and frailty are prevalent in community dwelling elderly in Thiruvananthapuram district. Frailty may be a risk factor for OH in the first minute. The number of co-morbidities may be an independent risk factor for OH. Hence, elderly people with comorbidities and cognitive impairment may be actively assessed for OH to prevent falls and associated injuries.