Orthostatic Hypotension in the Elderly: A Marker of Clinical Frailty?

Ilaria Liguori, Gennaro Russo, Vincenzo Coscia, Luisa Aran, Giulia Bulli, Francesco Curcio, David Della-Morte, Gaetano Gargiulo, Gianluca Testa, Francesco Cacciatore, Domenico Bonaduce, Pasquale Abete

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Background: Orthostatic hypotension (OH) has high prevalence in frail older adults. However, its effect on mortality, disability, and hospitalization in frail older adults is poorly investigated. Thus, we assessed the relationship between the prevalence of OH and its effect on mortality, disability, and hospitalization in noninstitutionalized older adults stratified by frailty degree. Methods: Prospective, observational study of 510 older participants (≥65 years of age) consecutively admitted to a geriatric evaluation unit to perform a geriatric comprehensive assessment. Measurements: Clinical frailty was assessed using the Italian frailty index (40 items). Systolic blood pressure (mm Hg), diastolic blood pressure (mm Hg), and heart rate (bpm) were evaluated in clinostatic position and after 1, 3, and 5 minutes of orthostatic position. OH was defined with a decrease of 20 mm Hg in systolic blood pressure and/or a decrease of 10 mm Hg in diastolic blood pressure. Results: OH prevalence was 22%, and it increased from 9.0% to 66.0% according to frailty degree (P for trend <.001). When stratified by frailty degree, mortality, disability, and hospitalization increased from 1.0% to 24.5%, from 39.0% to 77.0% and from 14.0% to 32.0% in the absence, and from 0.0% to 35.5%, from 42.0% to 95.5% and from 19.0% to 65.5% in the presence of OH, respectively (P <.01 vs absence of OH). Multivariate analysis showed that the Italian frailty index is more predictive of mortality, disability, and hospitalization in the presence than in the absence of OH. Conclusions: OH is a common condition in frail older adults, and it is strongly associated with mortality, disability, and hospitalization in the highest frailty degree. Thus, OH may represent a new marker of clinical frailty.

Original languageEnglish (US)
Pages (from-to)779-785
Number of pages7
JournalJournal of the American Medical Directors Association
Issue number9
StatePublished - Sep 2018
Externally publishedYes


  • Orthostatic hypotension
  • disability
  • frailty
  • hospitalization
  • mortality

ASJC Scopus subject areas

  • Nursing(all)
  • Health Policy
  • Geriatrics and Gerontology


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