July 1990

Hypotensive Responses to Common Daily Activities in Institutionalized ElderlyA Potential Risk for Recurrent Falls

Author Affiliations

From the Hebrew Rehabilitation Center for the Aged (Drs Jonsson and Lipsitz, Mss Kelley and Koestner), Joint Department of Medicine of Beth Israel and Brigham and Women's Hospitals (Drs Jonsson and Lipsitz), and the Division on Aging, Harvard Medical School (Drs Jonsson and Lipsitz), Boston, Mass. Dr Jonsson is now with the Reykjavik (Iceland) City Hospital.

Arch Intern Med. 1990;150(7):1518-1524. doi:10.1001/archinte.1990.00390190152026

• Transient hypotension may be one of many factors contributing to the high prevalence of falls among elderly people. To determine the frequency and magnitude of hypotensive responses to common daily activities, and their potential relationship to falls in the elderly, we examined blood pressure (BP) and heart rate during a standardized series of activities in 38 institutionalized recurrent fallers (age, 87±6 years), 20 institutionalized nonfallers (age, 85±5 years), and 10 healthy young control subjects (age, 24±3 years). The coefficient of variation for systolic BP during all activities was higher in elderly subjects (fallers, 14%±5%; nonfallers, 12%±3%) than in young control subjects (8%±1%). In contrast, the coefficient of variation for heart rate during all activities was higher in young subjects than in the elderly subjects. Elderly subjects had marked BP reduction following meals and nitroglycerin, which was significantly greater in fallers than in nonfallers, independent of the cause of the fall. Thus, institutionalized elderly have marked BP variability and hypotensive responses to meals and nitroglycerin. A decline in BP during common preload-reducing stresses may predispose some elderly people to falls.

(Arch Intern Med. 1990;150:1518-1524)