Refereed journal article or data article (A1)
Comprehensive geriatric assessment decreases prevalence of orthostatic hypotension in older persons
List of Authors: Lampela P, Lavikainen P, Huupponen R, Leskinen E, Hartikainen S
Publisher: SAGE PUBLICATIONS LTD
Publication year: 2013
Journal: Scandinavian Journal of Public Health
Journal name in source: SCANDINAVIAN JOURNAL OF PUBLIC HEALTH
Journal acronym: SCAND J PUBLIC HEALT
Number in series: 4
Volume number: 41
Issue number: 4
Start page: 351
End page: 358
Number of pages: 8
ISSN: 1403-4948
DOI: http://dx.doi.org/10.1177/1403494813475533
Abstract
Background: Orthostatic hypotension (OH) is associated with significant morbidity and mortality among older people. We have studied whether its prevalence can be reduced by a Comprehensive Geriatric Assessment (CGA). Study design and setting: 1000 randomly-selected persons aged ayen75 years were divided into intervention (n = 500) and control groups (n = 500). We focused on those subjects in whom an orthostatic blood pressure test had been performed at least once during the study period (2004-2007) (n = 365 and 332 for intervention and control groups, respectively). A CGA, including evaluation of the adequacy of the medication, was performed annually in the intervention group but not in the control group. We conducted Markov models to study change in the OH profiles and the effect of CGA on it. Competing risk of mortality was modeled as an absorbing state to avoid attrition bias. Results: Over 3 years, the prevalence of OH decreased (35.0% -> 28.0%) in the intervention group, whereas its prevalence increased in the control group (32.8% -> 40.8%). By Markov models it was shown that CGA had a statistically significant effect on recovering from OH. In addition, CGA was shown to protect from developing OH. Conclusions: Repeated CGA performed annually can reduce the prevalence of OH.
Background: Orthostatic hypotension (OH) is associated with significant morbidity and mortality among older people. We have studied whether its prevalence can be reduced by a Comprehensive Geriatric Assessment (CGA). Study design and setting: 1000 randomly-selected persons aged ayen75 years were divided into intervention (n = 500) and control groups (n = 500). We focused on those subjects in whom an orthostatic blood pressure test had been performed at least once during the study period (2004-2007) (n = 365 and 332 for intervention and control groups, respectively). A CGA, including evaluation of the adequacy of the medication, was performed annually in the intervention group but not in the control group. We conducted Markov models to study change in the OH profiles and the effect of CGA on it. Competing risk of mortality was modeled as an absorbing state to avoid attrition bias. Results: Over 3 years, the prevalence of OH decreased (35.0% -> 28.0%) in the intervention group, whereas its prevalence increased in the control group (32.8% -> 40.8%). By Markov models it was shown that CGA had a statistically significant effect on recovering from OH. In addition, CGA was shown to protect from developing OH. Conclusions: Repeated CGA performed annually can reduce the prevalence of OH.
Research Areas