title: Orthostatic haemodynamics may be impaired in frailty.
abstract: BACKGROUND
  orthostatic hypotension (OH) is a physical sign that reflects a final common pathway of various forms of disordered physiology, which is the hallmark of geriatric frailty. Fried et al. recognise three increasing frailty phenotypes in older people, based on measurements of weight loss, exhaustion, grip strength, walking speed and physical activity. Orthostatic haemodynamics have not been considered as markers of frailty in older people.
  
  
  OBJECTIVE
  to classify a community sample of older people into three increasing frailty phenotypes and compare their orthostatic haemodynamics.
  
  
  METHODS
  cross-sectional study.
  
  
  METHODS
  geriatric research clinic.
  
  
  METHODS
  a total of 442 subjects (mean age 72, 72% females) without dementia or risk factors for autonomic neuropathy.
  
  
  METHODS
  the sample was classified according to modified Fried criteria. Orthostatic systolic blood pressure (SBP), diastolic blood pressure (DBP) and heart rate (HR) responses were monitored during an active stand with Finometer®.
  
  
  RESULTS
  one hundred and ninety-eight subjects (44.8%) were classified as non-frail, 213 (48.2%) as pre-frail, and 31 (7.0%) as frail. Across groups, there was a significant increasing gradient in baseline HR (P = 0.008) and decreasing gradients in Delta HR (i.e. maximum HR within 30 s-baseline HR) (P < 0.001) and maximum HR by 30 s (P < 0.001). On average, by 30 s after stand, non-frail subjects had recovered 98% of their baseline SBP, while pre-frail and frail subjects had recovered 95 and 92%, respectively (P for trend = 0.064).
  
  
  CONCLUSIONS
  the orthostatic HR response and, to a lesser extent, SBP recoverability, appear impaired in frailty. Orthostatic haemodynamics may be useful markers of frailty.
authors.affiliation: Technology Research for Independent Living (TRIL) Centre, Trinity College Dublin and Mercer's Institute for Successful Ageing, Hospital 4, Top Floor, St James's Hospital, James's Street, Dublin 8, Ireland. romeror@tcd.ie
authors.forename: Roman
authors.initials: R
authors.lastname: Romero-Ortuno
authors.forename: Lisa
authors.initials: L
authors.lastname: Cogan
authors.forename: Diarmuid
authors.initials: D
authors.lastname: O'Shea
authors.forename: Brian A
authors.initials: BA
authors.lastname: Lawlor
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Kenny
mesh_terms: D000367:Age Factors; D000368:Aged; D001794:Blood Pressure; D016009:Chi-Square Distribution; D003430:Cross-Sectional Studies; D005260:Female; D016330:Frail Elderly; D006304:Health Status; D006305:Health Status Indicators; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007024:Hypotension, Orthostatic / Q000503:physiopathology*; D057187:Independent Living; D007494:Ireland; D016014:Linear Models; D008297:Male; D015999:Multivariate Analysis; D010641:Phenotype; D010865:Pilot Projects