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dc.contributor.authorThoburn, Steve
dc.contributor.authorCremin, Steve
dc.contributor.authorHolland, Mark
dc.date.accessioned2022-05-13T11:18:13Z
dc.date.available2022-05-13T11:18:13Z
dc.date.issued2022-03
dc.identifier.citationThoburn, S., 2022. An atypical presentation of orthostatic hypotension and falls in an older adult. British Paramedic Journal, 6 (4), 41-47.en_US
dc.identifier.doi10.29045/14784726.2022.03.6.4.41
dc.identifier.urihttp://hdl.handle.net/20.500.12417/1304
dc.description.abstractIntroduction: Falls are a significant cause of morbidity and mortality in older adults. Orthostatic hypotension (OH) is very common in this cohort of patients and is a significant risk for falls and associated injuries. We present the case of an 89-year-old female who fell at home, witnessed by her husband. OH was identified during the clinical assessment and considered to be the predominant contributing factor, although the clinical presentation was not associated with classical symptoms. Case presentation: The patient lost balance while turning away from the kitchen sink; she noted some instability due to a complaint of generalised weakness in both of her legs. No acute medical illness or traumatic injury was identified. A comprehensive history was obtained that identified multiple intrinsic and extrinsic risk factors for falling. The cardiovascular examination was unremarkable except for OH, with a pronounced reduction in systolic blood pressure of 34 mmHg at the three-minute interval and which reproduced some generalised weaknesses in the patient's legs and slight instability. Although classical OH symptoms were not identified, this was considered to be the predominant factor contributing to the fall. A series of recommendations was made to primary and community-based care teams based upon a rapid holistic review; this included a recommendation to review the patient's dual antihypertensive therapy. Conclusion: It is widely known that OH is a significant risk factor for falls, but asymptomatic or atypical presentations can make diagnosis challenging. Using the correct technique to measure a lying and standing blood pressure, as defined by the Royal College of Physicians, is crucial for accurate diagnosis and subsequent management. Ambulance clinicians are ideally placed to undertake this quick and non-invasive assessment to identify OH in patients that have fallen. Abstract published with permission.
dc.language.isoenen_US
dc.publisherThe College of Paramedicsen_US
dc.subjectEmergency Medical Servicesen_US
dc.subjectFallsen_US
dc.subjectParamedic Practiceen_US
dc.subjectOrthostatic Hypotensionen_US
dc.subjectAgeden_US
dc.titleAn atypical presentation of orthostatic hypotension and falls in an older adulten_US
dc.source.journaltitleBritish Paramedic Journalen_US
rioxxterms.versionNAen_US
rioxxterms.licenseref.urihttp://www.rioxx.net/licenses/all-rights-reserveden_US
rioxxterms.licenseref.startdate2022-04-21
rioxxterms.typeJournal Article/Reviewen_US
refterms.panelUnspecifieden_US
html.description.abstractIntroduction: Falls are a significant cause of morbidity and mortality in older adults. Orthostatic hypotension (OH) is very common in this cohort of patients and is a significant risk for falls and associated injuries. We present the case of an 89-year-old female who fell at home, witnessed by her husband. OH was identified during the clinical assessment and considered to be the predominant contributing factor, although the clinical presentation was not associated with classical symptoms. Case presentation: The patient lost balance while turning away from the kitchen sink; she noted some instability due to a complaint of generalised weakness in both of her legs. No acute medical illness or traumatic injury was identified. A comprehensive history was obtained that identified multiple intrinsic and extrinsic risk factors for falling. The cardiovascular examination was unremarkable except for OH, with a pronounced reduction in systolic blood pressure of 34 mmHg at the three-minute interval and which reproduced some generalised weaknesses in the patient's legs and slight instability. Although classical OH symptoms were not identified, this was considered to be the predominant factor contributing to the fall. A series of recommendations was made to primary and community-based care teams based upon a rapid holistic review; this included a recommendation to review the patient's dual antihypertensive therapy. Conclusion: It is widely known that OH is a significant risk factor for falls, but asymptomatic or atypical presentations can make diagnosis challenging. Using the correct technique to measure a lying and standing blood pressure, as defined by the Royal College of Physicians, is crucial for accurate diagnosis and subsequent management. Ambulance clinicians are ideally placed to undertake this quick and non-invasive assessment to identify OH in patients that have fallen. Abstract published with permission.en_US
dc.identifier.eissn1478-4726


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