Associations of orthostatic hypotension and frailty with dementia and mortality in older adults: a cohort study

Abstract

AbstractBackgroundOrthostatic hypotension (OH) has been considered a frailty marker and is associated with a higher risk of dementia and mortality. We sought to assess whether OH is associated with dementia and mortality in older adults while taking onto account frailty.MethodWe conducted a population‐based cohort study of 2703 dementia‐free individuals (mean age: 73.7; 63.3% females) from the Swedish National Study on Aging and Care in Kungsholmen, regularly followed from 2001‐2004 to 2016‐2019. OH was defined as systolic/diastolic blood pressure drops ≥20/10 mmHg one minute after standing up from a supine position. Fried’s frailty phenotype was used to assess frailty/pre‐frailty. Dementia was diagnosed following the DSM‐IV criteria. Individuals were cross‐classified into four groups based on their OH and frailty status and followed until dementia diagnosis, death, or dropout, whichever came first. Flexible parametric survival models with follow‐up time as the time scale were applied to estimate the associations of OH and frailty with dementia and mortality, adjusting for age, sex, education, vascular risk factors, and comorbidities. We also tested the interaction between OH and frailty on dementia or mortality risk on the multiplicative and additive scales.ResultDuring the follow‐up period, 418 (15.5%) individuals developed dementia, and 933 (34.5%) died without dementia. Compared with OH‐free and robust people, robust people with OH (adjusted HR = 1.90; 95% CI = 1.27‐2.86) had a higher risk of developing dementia. Pre‐frail/frail people without OH (HR = 1.67; 95% CI = 1.22‐2.28) and pre‐frail/frail people with OH (HR = 2.36; 95% CI = 1.62‐3.42) also had a higher dementia risk. Robust people with OH did not have a higher mortality hazard (HR = 1.11; 95% CI = 0.83‐1.48), but pre‐frail/frail people without OH (HR = 1.25; 95% CI = 1.04‐1.51) and pre‐frail/frail people with OH (HR = 1.55; 95% CI = 1.23‐1.94) had a higher mortality hazard than robust and OH‐free people. There was no evident interaction between OH and frailty on dementia or mortality risk on either the multiplicative or additive scale.ConclusionOlder adults with OH, whether robust or frail, may have a higher dementia risk than those without OH. Robust older adults with OH do not seem to have a higher mortality rate than robust older adults without OH.