Abstract
BackgroundOrthostatic hypotension (OH) is highly prevalent in older populations. It is associated with a reduced quality of life and an increased risk of dementia, stroke and death. Non-pharmalogical therapies are the recommended first-line therapy and are preferred to drug treatments by older people. However, uptake and adherence is low and evidence for their use is lacking. Objective: Determine the acceptability of non-pharmalogical interventions for OH in older people.MethodsThis qualitative study, nested within a phase II efficacy study, recruited 25 people aged over 60 years from a Falls and Syncope Clinic. All participants had experienced the following non-pharmalogical therapies within a phase II study: bolus water drinking, compression stockings, abdominal compression, physical counter-manoeuvres. Individual semi-structured qualitative interviews were recorded and transcribed verbatim. Emergent themes were identified through framework analysis of transcripts.ResultsPhysical counter-manoeuvres were considered the most acceptable therapy as no equipment is required, they can be performed discreetly and are only required during postural change. Bolus water drinking was mostly considered as an acceptable therapy, although there were significant concerns around urinary frequency. The idea of bolus water drinking was a barrier to its uptake, but once experienced it was easier than anticipated. Participants had mixed views on acceptability of abdominal compression whereas compression stockings were considered unacceptable by the majority of participants. This was due to the practicalities of applying/removing the compression and the stigma attached to their appearance.ConclusionsCurrent first-line treatment with compression stockings is largely unacceptable to older people with OH, challenging current guidelines. In order to promote uptake and adherence, first line therapy should focus on bolus-water drinking and physical counter-manoeuvres.
Highlights
Orthostatic hypotension (OH) is highly prevalent in older populations
Physical counter-manoeuvres (PCMs) were judged by this cohort to be largely acceptable, with a number of benefits over the other therapies, but perhaps its main advantage is that no equipment is required
Previous research demonstrating the effectiveness of PCMs in vasovagal syncope, employed continuous Blood pressure (BP) monitoring during the manoeuvres, as a means of biofeedback
Summary
Orthostatic hypotension (OH) is highly prevalent in older populations. It is associated with a reduced quality of life and an increased risk of dementia, stroke and death. Objective: Determine the acceptability of non-pharmalogical interventions for OH in older people. Orthostatic hypotension (OH) results from a sustained reduction in blood pressure (BP, ≥20 mmHg systolic or ≥ 10 mmHg diastolic) within 3 min of standing [1]. It is highly prevalent in the older population, affecting up to 20% of community-dwelling older people [2]. It is a disabling condition, resulting in reduced quality of life and Robinson et al BMC Geriatrics (2018) 18:315. If an intervention is deemed unacceptable, its effectiveness becomes irrelevant
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