Association between heart rate response during orthostatic test and falls in polymorbid patients aged 60 years and older

Abstract

Background. Orthostatic hypotension is a significant risk factor of falling in older adults. To diagnose the orthostatic hypotension an orthostatic test is used with assessment of heart rate (HR) response, systolic (SBP) and diastolic blood pressure (DBP) at the 3rd minute after the rise. However, according to studies, measurement of SBP and DBP at the 1st minute after rising can be more sensitive to detect older adults at risk of falling than at 3rd minute.Objective. The purpose of this study was to evaluate the role of changes in SBP, DBP and HR at the 1st, 2nd and 3rd minutes when performing an orthostatic test for identification of the elderly at high-risk of falls.Design and methods. This cross-sectional study included 100 adults aged 59+. Among them women comprise 56 % (n = 56). The following procedures were performed: the orthostatic test, anthropometry, medical history, assessment of drug treatment, depression evaluation, dementia and the degree of autonomy decline.Results. HR response at the 1st minute after the transition from horizontal to vertical position is more significant factor of falls risk than SBP and DBP changes during performing of orthostatic test. Absence of HR increasing during the transition from horizontal to vertical position associates with 10‑fold of risk falls among older adults: odds ratio 95 % confidence interval (OR 95 % CI) 10,5 (2,9–37,8). This association remained significant even after adjusting for age, gender, β-blockers use and comorbidity.Conclusion. Absence of HR increasing during the transition from horizontal to vertical position is a high sensitive marker of detecting older adults with polymorbidity in patients with the high risk of falls.