Autonomic dysfunction in the elderly: postural hypotension and related symptoms

ABSTRACT

BACKGROUND: Aging brings organic change and functional decline in men. An example of those functional declines is the functional change of autonomic nervous system, which is usually experienced as having postural hypotension as a typical symptom, and many other related symptoms as well. Thus, in order to study the autonamic dysfunctian caused by aging, we surveyed the occurring frequency of postural hypotension and its related symptoms, and investigated the relationship between such symptoms and the influence of external factors, in order care and treat the aged patients. METHODS: 396 people over the age of 65 years who visited the geriatric clinic located in Kwangju Park, during the period from April 1996 to August 1996, were investigated their characteristics, the related symptoms and external factors through interview, and examination to determine the presence of postural hypotension, checking the blood pressure and pulse rate in a recombent position after resting, one minute later when seated and then one minute later when standing. After in put of the data with SPSS/PC+, the statistical analysis was carried out using the Chi square and t-test. RESULTS: The 369 subjects consisted of 267 males and 129 females. The 93(23.5%) subjects showed postural hypotension, which appeared to have significant relationship with growing age but no significant relationship with the external factors such as sex, drinking, smoking, disease, medications, etc. However, under the pathological factors like disease and medication, the occurrence of postural hypotension were found to be somewhat high. The most frequent symptoms in order of seguence were postural symptoms (60.6%), impotence(58.8%), incantinence(21.0%), constipation(17.7%), diplopia(17.2%), decreased sweating(12.9%) and swallowing difficulty(7.3%), and all of these symptoms showed the significant relation with growing age. Postural symptoms were significantly related to postural hypotension, but other symptoms were not. And, postural symptoms had significant relationship with cerebrovascular disease. Also, postural symptoms showed the significant relationship with impotence, incontinence, constipation, diplopia and swallowing difficulty, but other symptoms were found to have no such relationship with each other and with the external factors. CONCLUSIONS: The aged people generally report symptoms caused by autonomic dysfunction. Especially postural symptoms are the most commonly experienced symptoms and, for the most part, accompanied by other symptoms, thus, the evaluation of autonomic dysfunction, especially on postural hypotension is important. And, since risk factors such as disease and medication influences the occurrence of postural hypotension, it should be appropriately considered when diagnosing and treating aged people. We think that continuous research on other risk factors and study to establish the proper guidelines to assess the autonomic dysfunction should be conducted in the future.