Orthostatic Hypotension and Falls in Older Adults: A Systematic Review and Meta-analysis

Arjen Mol, Phuong Thanh Silvie Bui Hoang, Sifat Sharmin, Esmee M. Reijnierse, Richard J.A. van Wezel, Carel G.M. Meskers, Andrea B. Maier

Research output: Contribution to JournalReview articleAcademicpeer-review

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 languageEnglish
Pages (from-to)589-597.e5
Number of pages14
JournalJournal of the American Medical Directors Association
Volume20
Issue number5
Early online date21 Dec 2018
DOIs
Publication statusPublished - 1 May 2019

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Orthostatic Hypotension
Meta-Analysis
Blood Pressure
Odds Ratio
PubMed
MEDLINE
Population
Longitudinal Studies
Cross-Sectional Studies
Databases
Confidence Intervals

Bibliographical note

Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

Keywords

  • accidental falls
  • aged
  • blood pressure
  • humans
  • Orthostatic hypotension

Cite this

Mol, Arjen ; Bui Hoang, Phuong Thanh Silvie ; Sharmin, Sifat ; Reijnierse, Esmee M. ; van Wezel, Richard J.A. ; Meskers, Carel G.M. ; Maier, Andrea B. / Orthostatic Hypotension and Falls in Older Adults : A Systematic Review and Meta-analysis. In: Journal of the American Medical Directors Association. 2019 ; Vol. 20, No. 5. pp. 589-597.e5.
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Orthostatic Hypotension and Falls in Older Adults : A Systematic Review and Meta-analysis. / Mol, Arjen; Bui Hoang, Phuong Thanh Silvie; Sharmin, Sifat; Reijnierse, Esmee M.; van Wezel, Richard J.A.; Meskers, Carel G.M.; Maier, Andrea B.

In: Journal of the American Medical Directors Association, Vol. 20, No. 5, 01.05.2019, p. 589-597.e5.

Research output: Contribution to JournalReview articleAcademicpeer-review

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AU - Bui Hoang, Phuong Thanh Silvie

AU - Sharmin, Sifat

AU - Reijnierse, Esmee M.

AU - van Wezel, Richard J.A.

AU - Meskers, Carel G.M.

AU - Maier, Andrea B.

N1 - Copyright © 2018 AMDA – The Society for Post-Acute and Long-Term Care Medicine. Published by Elsevier Inc. All rights reserved.

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N2 - 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.

AB - 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.

KW - accidental falls

KW - aged

KW - blood pressure

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KW - Orthostatic hypotension

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