Abstract
Background
Postural hypotension is defined as a reduction in systolic blood pressure of ≥20mmHg or diastolic blood pressure of ≥10mmHg that occurs within 3 minutes of standing [1]. Given that postural hypotension can result in unexplained falls [2,3], current NICE guidance recommends measurement of postural blood pressure (BP) in patients aged 65 years and over that present to secondary care following a fall [4]. Aims To record outcomes related to postural BP measurements, all-cause and fall-related readmission and mortality.
Methods
We conducted an audit of patients aged over 80 attending ED as a consequence of a fall between 24th and 30th October 2022. We recorded whether postural BP was requested, recorded and reviewed. As this was a retrospective audit, it enabled a 6-month follow-up period to measure subsequent hospital attendance, falls related admissions and mortality outcomes.
Results
41 patients were identified, with a mean age of 88. 9 had a postural BP requested, 6 had measurements recorded. 2 were performed in line with current NICE guidance[4]. 2 patients met diagnostic criteria for postural hypotension[1]. One was not on causative medications and the other had BP medications reduced as a consequence. Over half of the patients presenting with falls were admitted again within the 6 month follow-up (n=21), with 12 attendances due to falls.
Conclusion
Falls are a common presentation to secondary care in patients aged 80 years and over. Postural blood pressure is an important component of a multi-factorial falls assessment. This audit has shown low rates of postural BP measurement in this group, with low adherence to guidelines. Measuring and responding to postural BP may reduce future falls and readmissions.