title: Impaired Orthostatic Blood Pressure Recovery Is Associated with Unexplained and Injurious Falls.
abstract: OBJECTIVE
  Cardiovascular disorders are recognized as important modifiable risk factors for falls. However, the association between falls and orthostatic hypotension (OH) remains ambivalent, particularly because of poor measurement methods of previous studies. The goal was to determine for the first time to what extent OH (and variants) are risk factors for incident falls, unexplained falls (UF), injurious falls (IF) and syncope using dynamic blood pressure (BP) measurements in a population study.
  
  
  METHODS
  Nationally representative longitudinal cohort study-The Irish Longitudinal Study on Ageing (TILDA)-wave 1 (2009-2011) with 2-year follow-up at wave 2 (2012-2013).
  
  
  METHODS
  Community-dwelling adults.
  
  
  METHODS
  Four thousand one hundred twenty-seven participants were randomly sampled from the population of older adults aged ≥50 years resident in Ireland.
  
  
  METHODS
  Continuous BP recordings measured during active stands were analyzed. OH and variants (initial OH and impaired orthostatic BP stabilization OH(40)) were defined using dynamic BP measurements. Associations with the number of falls, UF, IF, and syncope reported 2 years later were assessed using negative binomial and modified Poisson regression as appropriate.
  
  
  RESULTS
  Participants had a mean age of 61.5 (8.2) years (54.2% female). OH(40) was associated with increased relative risk of UF (RR: 1.52 95% CI: 1.03-2.26). OH was associated with all-cause falls (IRR: 1.40 95% CI: 1.01-1.96), UF(RR: 1.81 95% CI: 1.06-3.09), and IF(RR: 1.58 95% CI: 1.12-2.24). IOH was not associated with any outcome.
  
  
  CONCLUSIONS
  With the exception of initial orthostatic hypotension, beat-to-beat measures of impaired orthostatic BP recovery (delayed recovery OH (40) or sustained orthostatic hypotension OH) are independent risk factors for future falls, unexplained falls, and injurious falls.
authors.affiliation: The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.|Department of Medical Physics and Bioengineering, Dublin, Ireland.|Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland.
authors.forename: Ciarán
authors.initials: C
authors.lastname: Finucane
authors.affiliation: The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
authors.forename: Matthew D L
authors.initials: MD
authors.lastname: O'Connell
authors.affiliation: The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.
authors.forename: Orna
authors.initials: O
authors.lastname: Donoghue
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Richardson
authors.affiliation: School of Health Sciences, University of East Anglia, Norwich Research Park, Norwich, UK.
authors.forename: George M
authors.initials: GM
authors.lastname: Savva
authors.affiliation: The Irish Longitudinal Study on Ageing (TILDA), Department of Medical Gerontology, Trinity College Dublin, Dublin, Ireland.|Mercer's Institute for Successful Ageing, St. James's Hospital, Dublin, Ireland.
authors.forename: Rose Anne
authors.initials: RA
authors.lastname: Kenny
mesh_terms: D000058:Accidental Falls / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D001795:Blood Pressure Determination; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007024:Hypotension, Orthostatic / Q000453:epidemiology*; D007494:Ireland / Q000453:epidemiology; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D020127:Recovery of Function; D012307:Risk Factors; D013575:Syncope / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology*
keywords: falls risk; impaired orthostatic blood pressure stabilization; injurious falls; orthostatic hypotension; unexplained falls