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Published on: November 7, 2014
Comprehensive geriatric assessment decreases prevalence of orthostatic hypotension in older persons
Pasi Lampela1, Piia Lavikainen, Risto Huupponen
1Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. Pasi.Lampela@uef.fi
Insights
Annual Comprehensive Geriatric Assessment (CGA) significantly reduced the prevalence of orthostatic hypotension (OH) in older adults. This intervention helped patients recover from OH and prevented new cases, highlighting CGA
Area of Science:
- Geriatrics
- Cardiovascular Medicine
- Public Health
Background:
- Orthostatic hypotension (OH) is a significant health concern in older populations, linked to increased morbidity and mortality.
- Investigating interventions to mitigate OH prevalence is crucial for geriatric care.
Purpose of the Study:
- To determine if Comprehensive Geriatric Assessment (CGA) can reduce the prevalence of orthostatic hypotension (OH) in elderly individuals.
- To evaluate the long-term impact of repeated CGA on OH development and recovery.
Main Methods:
- A randomized controlled trial involving 1000 individuals aged ≥75 years, with 500 in the intervention group receiving annual CGA and 500 in the control group.
- Utilized Markov models to analyze changes in OH prevalence and the effect of CGA, incorporating competing risks of mortality.
- Focused analysis on participants with at least one orthostatic blood pressure test during the study period (2004-2007).
Main Results:
- The intervention group receiving annual CGA experienced a decrease in OH prevalence from 35.0% to 28.0% over three years.
- Conversely, the control group saw an increase in OH prevalence from 32.8% to 40.8%.
- Markov models confirmed that CGA had a statistically significant positive effect on OH recovery and prevention.
Conclusions:
- Annual Comprehensive Geriatric Assessment (CGA) is an effective strategy for reducing the prevalence of orthostatic hypotension (OH) in older adults.
- Regular CGA can lead to recovery from existing OH and protect against the development of new cases.
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 ≥75 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.
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