Orthostatic Hypotension in the Elderly: A Forgotten Predictor of Falls, Frailty, and Functional Decline

Abstract

A persistent drop in systolic blood pressure of at least 20 mmHg or diastolic blood pressure of at least 10 mmHg within three minutes of standing is known as orthostatic hypotension (OH), a common geriatric syndrome. About 20% of senior citizens living in the community and up to 60% of those living in institutions are affected by OH, which is a major cause of falls, frailty, functional decline, cognitive impairment, and higher mortality. The pathophysiology of OH in the elderly is complex and includes common comorbidities like diabetes, Parkinson's disease, and polypharmacy, as well as impaired autonomic nervous system function, decreased baroreflex sensitivity, vascular stiffness, and diminished cardiac responsiveness. When standing, these alterations result in insufficient cerebral perfusion, which can cause light-headedness, syncope, and an elevated risk of falls. Owing to temporary symptoms and inadequate blood pressure monitoring procedures, OH is still underdiagnosed despite its clinical significance. For the frail elderly, multimodal management strategies that include both pharmaceutical therapies and non-pharmacologic measures have proven beneficial in lowering complications.

Artificial intelligence, wearable technology, and continuous blood pressure monitoring have the potential to improve OH detection and individualized treatment in the future. In order to lessen the substantial impact of OH on geriatric health, this review emphasizes the current knowledge, research gaps, and clinical implications of OH in older adults. It also highlights the need for increased awareness and focused interventions.