title: The association between orthostatic hypotension, falling and successful rehabilitation in a nursing home population.
abstract: OBJECTIVE
  Our objectives were to identify the prevalence of orthostatic hypotension (OH) in frail, elderly nursing home residents, and assess its possible association with falling and chances of successful rehabilitation.
  
  
  METHODS
  A prospective observational cohort study. A total of 290 patients participated in this study, of which 128 were admitted to the rehabilitation department. OH was defined as a drop in systolic blood pressure of >20mmHg and diastolic blood pressure of >10mmHg after postural change within 3min. The analyses regarding falling and successful rehabilitation were only performed in the rehabilitation group. Multivariate binary logistic regression analyses were used to describe risk factors related with falling. Cox proportional hazard modeling was used to investigate the relation between OH and the time to successful rehabilitation.
  
  
  RESULTS
  The prevalence of OH in the studied nursing home population was 36.6% (95% CI (confidence interval): 31.1-42.1%). The prevalence varied from 28.6% (95% CI: 16.8-40.4%) in somatic patients, 36.7% (95% CI: 28.4-45.1%) in rehabilitation patients, to 40.6% (95% CI: 31.3-50.0%) in psychogeriatric patients. The association between orthostatic hypotension and previous falling was not significant; Odds ratio 0.66 (95% CI: 0.30-1.48). The Hazard ratio of the relationship between OH and successful rehabilitation was 2.88 (95% CI:1.77-4.69).
  
  
  CONCLUSIONS
  OH is highly prevalent in nursing home residents. Surprisingly, patients with OH were found to have a higher chance of successful rehabilitation compared to patients without OH. If confirmed in other studies, these results may change our view of the implications of OH.
authors.affiliation: Diabetes Centre, Isala, P.O. Box 10400, 8000 GK Zwolle, The Netherlands. Electronic address: l.c.hartog@isala.nl.
authors.forename: L C
authors.initials: LC
authors.lastname: Hartog
authors.affiliation: TriviumMeulenbeltZorg, PC Borstlaan 10, 7555 SH Hengelo, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Cizmar-Sweelssen
authors.affiliation: TriviumMeulenbeltZorg, PC Borstlaan 10, 7555 SH Hengelo, The Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: Knipscheer
authors.affiliation: Diabetes Centre, Isala, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; University Medical Center Groningen and University of Groningen, Department of General Practice, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands.
authors.forename: K H
authors.initials: KH
authors.lastname: Groenier
authors.affiliation: Diabetes Centre, Isala, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; University Medical Center Groningen and University of Groningen, Department of Internal Medicine, Hanzeplein 1, 9700 RB Groningen, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Kleefstra
authors.affiliation: Diabetes Centre, Isala, P.O. Box 10400, 8000 GK Zwolle, The Netherlands; University Medical Center Groningen and University of Groningen, Department of Internal Medicine, Hanzeplein 1, 9700 RB Groningen, The Netherlands; Isala, Department of Internal Medicine, Dokter van Heesweg 2, 8025 AB Zwolle, The Netherlands.
authors.forename: H J G
authors.initials: HJ
authors.lastname: Bilo
authors.affiliation: Diabetes Centre, Isala, P.O. Box 10400, 8000 GK Zwolle, The Netherlands.
authors.forename: K J J
authors.initials: KJ
authors.lastname: van Hateren
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D001794:Blood Pressure / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D016330:Frail Elderly; D006801:Humans; D007024:Hypotension, Orthostatic / Q000453:epidemiology* / Q000534:rehabilitation*; D015994:Incidence; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands / Q000453:epidemiology; D009735:Nursing Homes; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
keywords: Blood pressure; Fall risk; Nursing home residents; Orthostatic hypotension