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Postural and Prandial Tolerance in Severely Frail Older People A Study in Long-term Geriatric Care

Jochanan E Naschitz, Irena Kozel, Anatoli Nemoi, Gregory Leibovitz, Yigal Avital and Peri Ofri

Objective: To assess frail older peoples’ tolerance to every-day postural and prandial challenges.

Design: Prospective cohort study.

Subjects: Older persons, bed and chair confined, hospitalized in long-term geriatric or hospice care, unfit to undergo customary postural and prandial testing.

Methods: Blood pressure (BP) and heart rate (HR) were measured with an automatic device in three situations: supine at 7 am; sitting before lunch at 12 pm., and continuing sitting 30 minutes after lunch. The patients’ alertness and symptoms were assessed at 7 am., 12.00 and 12.40. BP changes were calculated: supine to sitting, and sitting before lunch to sitting after lunch. BP changes were related to incident symptoms.

Results: The meal was discontinued in two patients when a vasovagal reaction and dumping syndrome occurred. Sixty three tests in 48 patients were completed. The average supine systolic BP (SBP) was 121.2 ± 16.8 mmHg and the diastolic BP (DBP) 67.7 ± 10.5 mmHg. The average difference between supine SBP and sitting before lunch SBP was 3.2 ±19.2 mmHg, the DBP difference was 4.7 ± 10.8 mmHg (p=0.0003). The average difference between SBP sitting before lunch and SBP sitting after lunch was 0.4 ±12 mmHg, the DBP difference was 0.7 ± 7.5 mmHg. Orthostatic hypotension (OH) and/or postprandial hypotension (PPH) was present in 31/63 (47.6%) of tests: all patients remained free of symptoms during testing and the mean BP in all measurements was >60 mmHg.

Conclusions: A large proportion of severely frail older patients tolerated every-day postural and prandial challenges, even when asymptomatic OH and/or PPH occurred.