title: Comprehensive geriatric assessment decreases prevalence of orthostatic hypotension in older persons.
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).
  
  
  METHODS
  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.
authors: Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland. Pasi.Lampela@uef.fi
authors: Pasi
authors: P
authors: Lampela
authors: Piia
authors: P
authors: Lavikainen
authors: Risto
authors: R
authors: Huupponen
authors: Esko
authors: E
authors: Leskinen
authors: Sirpa
authors: S
authors: Hartikainen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D015577:Geriatric Assessment / Q000379:methods*; D006801:Humans; D007024:Hypotension, Orthostatic / Q000453:epidemiology* / Q000517:prevention & control*; D008297:Male; D008390:Markov Chains; D008962:Models, Theoretical; D015995:Prevalence
keywords: Attrition bias; Markov models; comprehensive geriatric assessment; longitudinal; older people; orthostatic hypotension