Abstract
OBJECTIVES: Orthostatic hypotension is a potential risk factor for falls in older adults, but existing evidence on this relationship is inconclusive. This study addresses the association between orthostatic hypotension and falls.
DESIGN: Systematic review and meta-analysis of the cross-sectional and longitudinal studies assessing the association between orthostatic hypotension and falls, as preregistered in the PROSPERO database (CRD42017060134).
SETTING AND PARTICIPANTS: A literature search was performed on February 20, 2017, in MEDLINE (from 1946), PubMed (from 1966), and EMBASE (from 1947) using the terms orthostatic hypotension, postural hypotension, and falls. References of included studies were screened for other eligible studies. Study selection was performed independently by 2 reviewers using the following inclusion criteria: published in English; mean/median age of the population ≥65 years; blood pressure measurement before and after postural change; and assessment of the association of orthostatic hypotension with falls. The following studies were excluded: conference abstracts, case reports, reviews, and editorials. Data extraction was performed independently by 2 reviewers.
MEASURES: Unadjusted odds ratios of the association between orthostatic hypotension and falls were used for pooling using a random effects model. Studies were rated as high, moderate, or low quality using the Newcastle-Ottawa Scale.
RESULTS: Out of 5646 studies, 63 studies (51,800 individuals) were included in the systematic review and 50 studies (49,164 individuals) in the meta-analysis. Out of 63 studies, 39 were cross-sectional and 24 were longitudinal. Orthostatic hypotension was positively associated with falls (odds ratio 1.73, 95% confidence interval 1.50-1.99). The result was independent of study population, study design, study quality, orthostatic hypotension definition, and blood pressure measurement method.
CONCLUSIONS AND IMPLICATIONS: Orthostatic hypotension is significantly positively associated with falls in older adults, underpinning the clinical relevance to test for an orthostatic blood pressure drop and highlighting the need to investigate orthostatic hypotension treatment to potentially reduce falls.
Original language | English |
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Pages (from-to) | 589-597.e5 |
Number of pages | 14 |
Journal | Journal of the American Medical Directors Association |
Volume | 20 |
Issue number | 5 |
Early online date | 21 Dec 2018 |
DOIs | |
Publication status | Published - May 2019 |
Bibliographical note
Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.Funding
This study was supported by the Netherlands Organisation for Scientific Research (NWO, Utrecht, The Netherlands, Grant No. 14901); and the European Union's Horizon 2020 research and innovation programme (Grant No. 689238 and 675003). We thank Rikie Deurenberg from the Radboud University Library, who greatly assisted with the construction of the search strategy.
Funders | Funder number |
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Radboud University Library | |
Horizon 2020 Framework Programme | 689238, 675003 |
Nederlandse Organisatie voor Wetenschappelijk Onderzoek | 14901 |
Keywords
- accidental falls
- aged
- blood pressure
- humans
- Orthostatic hypotension