Postprandial Hypotension and Impaired Postprandial Sustained and Selective Attention in Older Inpatients: Is There a Link?

OBJECTIVES: The study aimed to investigate the prevalence of postprandial hypotension (PPH) in older inpatients, to verify the overall postprandial behavior of blood pressure and attentional performances, and to explore the overall associations between blood pressure (including PPH) and attentional performances. Eventually, we aimed to investigate differences on PPH, blood pressure values and attentional performances based on the subjects' frailty status. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: A sample of older inpatients at the Geriatric Unit of the University Hospital of Messina (Italy). METHODS: Basal, preprandial, and postprandial blood pressures (75 minutes after the meal) were measured for each patient; PPH was detected according to its empirical definition. Global cognitive functioning, and sustained and selective attention were assessed; a 46-item Frailty Index was calculated. RESULTS: The sample consisted of 112 inpatients (54 females), with a mean age of 80.9 years. The prevalence of PPH was 30.4%; in the postprandial window, a reduction in blood pressure between 10 and 20 mm Hg and a reduction of >20 mm Hg were reported by 27.1% and 29.9% of inpatients, respectively. In the postprandial evaluation, sustained and selective attention markedly decreased. No significant associations were found between PPH occurrence and the postprandial dip of attentional performances, and no significant cognitive differences were found between inpatients with and without PPH. On the other hand, reduced postprandial attentional performances were associated especially with preprandial lower systolic and diastolic blood pressure values. Ultimately, no significant differences in PPH occurrence were found between frail and nonfrail inpatients; frail inpatients significantly exhibited also an overall lower cognitive functioning. CONCLUSIONS AND IMPLICATIONS: In our sample, PPH and impaired postprandial attentional performances were not associated, even though this association deserves further investigation. In hospitalized older adults, the accurate management of blood pressure levels appears relevant, because we evidenced that low blood pressure (especially preprandial) was associated with poor attentional functioning. Although the plausible occurrence of several interfering and confounder factors was observed in an acute care setting, we consider that the screening of attentional functioning among hospitalized older patients could be helpful.

Frailty modifications and prognostic impact in older patients admitted in acute care.

BACKGROUND: Frailty is a predictor of adverse outcomes in older subjects. AIMS: The aims of this study are to (1) measure the frailty status and its changes occurring during the hospital stay, (2) determine the relationships among frailty and adverse outcomes. METHODS: Frailty was assessed using a 46-item Frailty Index (FI) in 156 patients admitted to an Acute Geriatric Medicine Unit. The FI was calculated within 24 h from the hospital admission (aFI) and at his/her discharge (dFI). Patients were followed up to 12 months after the hospital discharge. RESULTS: A statistically significant difference was reported between the aFI (0.31, IQR 0.19-0.44) and the dFI (0.29, IQR 0.19-0.40; p = 0.04). The aFI was directly associated with the risk of in-hospital death (OR = 5.9; 95% CI 2.0-17.5; p = 0.001), 1 year mortality (OR = 5.5, 95% CI 2.4-12.7, p < 0.001) and re-hospitalization (OR = 6.3, 95% CI 2.2-17.9, p = 0.03). CONCLUSION: Frailty is a strong predictor of negative endpoints in hospitalized older persons. DISCUSSION: Frailty assessment from routinely collected clinical data may provide important insights about the biological status of the individual and promote the personalization of care.

Relationship between blood pressure and frailty in older hypertensive outpatients.

BACKGROUND: The benefits and risks of treating hypertension in old and frail patients are debated. AIM: The aim of the present study is to measure the frailty status in older patients with hypertension and determine the relationships existing between blood pressure (BP) values and frailty. METHODS: Frailty was retrospectively assessed by using the frailty index (FI) in 56 hypertensive old outpatients. Patients with an FI > 0.25 were classified as frail. RESULTS: Forty-five out of 56 (80%) had a FI > 0.25. A statistically significant inverse correlation was found between FI and systolic BP (r = -0.319, p = 0.016), orthostatic systolic BP (r = -0.408, p = 0.002), orthostatic diastolic BP (r = -0.299, p = 0.025), and orthostatic pulse pressure (r = -0.297, p = 0.026). DISCUSSION: Frailer subjects appear as over-treated according to current European guidelines. CONCLUSIONS: FI can play an important role in the clinical setting by supporting the identification of subjects at risk and allowing an improved provision of adapted and personalized care.