Image of Andrea B. Maier, M.D., Ph.D.; Image credit:VU University Amsterdam

Older rehabilitation patients should be assessed for symptoms of orthostatic intolerance upon admission, a new study suggests.

The condition can cause symptoms of lightheadedness, fainting and an uncomfortable, rapid increase in heartbeat when upright and is often a signal that an older adult is in relatively poor health, the researchers said.

The investigators followed the health progress of 1,505 rehabilitation patients in a tertiary teaching hospital in Melbourne, Australia. They aimed to pinpoint how often these patients had symptoms of orthostatic hypotension (OH) — where blood pressure falls upon standing —  and orthostatic intolerance symptoms, and how often these symptoms occurred together.

In the “Restoring the health of acutely unwell adults,” or RESORT, study, OH was defined as a drop in systolic blood pressure by 20 mm Hg or more, and/or a drop in diastolic blood pressure by 10 mm Hg or more within three minutes of moving from supine to a standing or sitting position. ​​The researchers recorded symptoms following the three minutes.

Fully 20% of these older rehabilitation patients had OH and orthostatic intolerance symptoms, although the co-occurrence of symptoms was low, according to Andrea B. Maier, M.D., Ph.D., of VU University Amsterdam, The Netherlands, and colleagues.

In addition, study participants with OH or symptoms showed poorer physical performance, functional independence and cognitive health, had more comorbidities and geriatric conditions, and longer length of rehab stays, the researchers reported. 

Patients who have orthostatic intolerance symptoms are likely to be in poor health, and these symptoms should be assessed in clinical practice, independent of an OH diagnosis, they said.

“I[]t is imperative to assess all geriatric rehabilitation inpatients on admission for OH and the presence of orthostatic intolerance symptoms, preferably through active standing,” they concluded.

The study was published Tuesday in JAMDA.