Introduction

Approximately 50 % of residents in long-term care facilities fall yearly and orthostatic hypotension accounts for a significant portion of them. Neurogenic orthostatic hypotension - a subtype of orthostatic hypotension – is important to be recognized as its management is far more complex; undertreatment of these older adults can lead to recurrent falls, high healthcare cost burden, and increased morbidity and mortality. The primary purpose of our study was to describe the rate of neurogenic orthostatic hypotension in older adults in a long-term care facility, with a secondary purpose to describe risk factors for neurogenic orthostatic hypotension in this population.

Methods

We conducted a retrospective case-control study of residents with recurrent falls at the Dayton Veteran's Affairs long-term care facility. Charts were manually reviewed. Inclusion criterion was three or more falls and age 65 or greater; we did not have exclusion criteria.

ICD10 codes and most recent primary care physician notes were used to identify comorbidity diagnoses. Recent orthostatic vitals were used to assess orthostatic hypotension or neurogenic orthostatic hypotension diagnoses.

Results

Of our sample of 224 residents, we observed a prevalence of 20.5 % for neurogenic orthostatic hypotension and 32.1 % for orthostatic hypotension. Neither of them had diagnosis of neurogenic orthostatic hypotension documented. Parkinson's disease was associated with neurogenic orthostatic hypotension (OR-4.3; p = 0.002). Hypertension was prevalent in 69.6 % of residents with orthostatic vitals suggestive of neurogenic orthostatic hypotension.

Conclusion

Older adults with recurrent falls at a long-term care facility meet criteria for neurogenic orthostatic hypotension diagnosis far more often than is documented. Common comorbidities associated with neurogenic orthostatic hypotension in this population include Parkinson's disease.

中文翻译：

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反复跌倒的长期护理机构居民神经源性直立性低血压的回顾性分析

介绍

长期护理机构中约有 50% 的居民每年都会跌倒，其中直立性低血压占其中很大一部分。神经源性直立性低血压（直立性低血压的一种亚型）的认识非常重要，因为其治疗要复杂得多；对这些老年人的治疗不足可能会导致反复跌倒、高昂的医疗费用负担以及发病率和死亡率的增加。我们研究的主要目的是描述长期护理机构中老年人神经源性直立性低血压的发生率，次要目的是描述该人群中神经源性直立性低血压的危险因素。

方法

我们对代顿退伍军人事务部长期护理机构经常跌倒的居民进行了一项回顾性病例对照研究。图表经过人工审核。纳入标准为跌倒 3 次或以上且年龄在 65 岁或以上；我们没有排除标准。

ICD10 代码和最近的初级保健医生笔记用于识别合并症诊断。最近的直立性生命体征用于评估直立性低血压或神经源性直立性低血压诊断。

结果

在我们的 224 名居民样本中，我们观察到神经源性直立性低血压的患病率为 20.5%，直立性低血压的患病率为 32.1%。他们两人都没有神经源性直立性低血压的诊断记录。帕金森病与神经源性直立性低血压相关（OR-4.3；p  = 0.002）。69.6% 患有直立性生命体征的居民患有高血压，提示神经源性直立性低血压。

结论

在长期护理机构中反复跌倒的老年人符合神经源性直立性低血压诊断标准的情况比记录的要多得多。该人群中与神经源性直立性低血压相关的常见合并症包括帕金森病。