scholarly journals The efficacy of nonpharmacologic intervention for orthostatic hypotension associated with aging

Neurology ◽  
2018 ◽  
Vol 91 (7) ◽  
pp. e652-e656 ◽  
Author(s):  
Julia L. Newton ◽  
James Frith
Keyword(s):  
Older People ◽  
Orthostatic Hypotension ◽  
Response Rate ◽  
Cardiovascular Responses ◽  
Class Iii ◽  
Abdominal Compression ◽  
Compression Stockings ◽  
Water Drinking ◽  
Nonpharmacologic Intervention

ObjectiveTo determine the efficacy and safety of nonpharmacologic interventions for orthostatic hypotension (OH) secondary to aging.MethodsA total of 150 orthostatic challenges were performed in 25 older people (age 60–92 years) to determine cardiovascular responses to bolus water drinking, compression stockings, abdominal compression, and physical countermaneuvers. Primary outcome was response rate as assessed by proportion of participants whose systolic blood pressure (SBP) drop improved by ≥10 mm Hg.ResultsThe response rate to bolus water drinking was 56% (95% confidence interval [CI] 36.7–74.2), with standing SBP increasing by 12 mm Hg (95% CI 4–20). Physical countermaneuvers were efficacious in 44% (95% CI 25.8–63.3) but had little effect on standing SBP (+7.5 mm Hg [95% CI −1 to 16]). Abdominal compression was efficacious in 52% (95% CI 32.9–70.7) and improved standing SBP (+10 mm Hg [95% CI 2–18]). Compression stockings were the least efficacious therapy (32% [95% CI 16.1–51.4]) and had little effect on standing SBP (+6 mm Hg [95% CI −1, 13]). No intervention improved symptoms during standing. There were no adverse events.ConclusionsBolus water drinking should become the standard first-line nonpharmacologic intervention, whereas compression stockings should be disregarded in this population.Classification of evidenceThis study provides Class III evidence that for older people with OH, bolus water drinking is superior to other nonpharmacologic interventions in decreasing SBP drop.

scholarly journals Combination non-pharmacologic intervention for orthostatic hypotension in older people: a phase 2 study

2019 ◽  
Vol 49 (2) ◽  
pp. 253-257
Author(s):  
James Frith ◽  
Julia L Newton
Keyword(s):  
Older People ◽  
Orthostatic Hypotension ◽  
Response Rate ◽  
Pharmacologic Therapy ◽  
Phase 2 ◽  
First Line ◽  
Water Drinking ◽  
First Line Therapy ◽  
Prospective Phase ◽  
Older Populations

Abstract Background orthostatic hypotension (OH) is highly prevalent in older populations and is associated with reduced quality of life and increased mortality. Although non-pharmacologic therapies are recommended first-line, evidence for their use is lacking. Objective determine the efficacy of combination non-pharmacologic therapy for OH in older people. Methods a total of 111 orthostatic BP responses were evaluated in this prospective phase 2 efficacy study in 37 older people (≥60 years) with OH. Primary outcome was the proportion of participants whose systolic BP drop improved by ≥10 mmHg. Secondary outcomes include standing BP and symptoms. Comparison is made to the response rate of the most efficacious single therapy (bolus water drinking 56%). Therapeutic combinations were composed of interventions with known efficacy and tolerability: Therapy A- Bolus water drinking + physical counter-manoeuvres (PCM); Therapy B- Bolus water drinking + PCM + abdominal compression. Results the response rate to therapy A was 38% (95% confidence interval – CI 24, 63), with standing systolic BP increasing by 13 mmHg (95% CI 4, 22). Therapy B was efficacious in 46% (95% CI 31, 62), increasing standing systolic BP by 20 mmHg (95% CI 12, 29). Neither therapy had a significant effect on symptoms. There were no adverse events. Conclusions in comparison to single therapy, there is little additional benefit to be gained from combination non-pharmacologic therapy. Focussing on single, efficacious therapies, such as bolus water drinking or PCM, should become standard first-line therapy.

scholarly journals 19 The Efficacy, Safety and Acceptability of Non-Pharmacologic Therapy for Orthostatic Hypotension in Older People: A Mixed Methods Study

2019 ◽  
Vol 48 (Supplement_4) ◽  
pp. iv6-iv8
Author(s):  
James Frith ◽  
Lisa Robinson ◽  
Julia Newton
Keyword(s):  
Mixed Methods ◽  
Older People ◽  
Response Rates ◽  
Mixed Methods Study ◽  
Current Evidence ◽  
Pharmacologic Therapy ◽  
Abdominal Compression ◽  
Compression Stockings ◽  
First Line ◽  
Water Drinking

Abstract Introduction First-line treatment for OH is typically with non-pharmacologic therapy. However, the current evidence base is poor, particularly in older people. Aim Determine the safety, efficacy and acceptability of single and combination therapies for OH in older people. Methods A three-stage, mixed-methods study consisting of a phase 2 efficacy study with a nested qualitative study. Stage One calculated response rates to therapy (defined as an improvement in standing systolic blood pressure (SSBP) by ≥10 mmHg). Stage Two explored the tolerability of therapies in qualitative interviews. Stage Three evaluated response rates to combinations of the most efficacious and tolerable therapies. All participants were aged ≥60 years, had OH and were recruited from a UK Falls and Syncope Service. Results Stage One. Response rates to therapies were evaluated in 25 older people (74 years, 60-92): Bolus-water drinking 56% (95%CI 35, 76); abdominal compression 52% (95%CI 31, 72), physical counter-maneuvers 44% (PCM, 95%CI 24, 65), full-leg length compression 32% (95%CI 15, 54). Stage Two. PCM was considered an acceptable therapy as no equipment is required, is only needed during postural change and can be performed conspicuously. Water was largely acceptable but there were concerns around urinary frequency. Compression stockings were considered unacceptable due to cosmesis, practicalities and discomfort. There were mixed views on the tolerability of abdominal compression. There were no adverse events. Stage Three. Response rates to combination therapy were evaluated in 37 older people (71 years, 60-94). Bolus water drinking + PCM 38% (95%CI 22, 55); water + PCM + abdominal compression 46% (95%CI 29, 63). Conclusions Due to its superior efficacy, safety and acceptability, bolus water drinking should become standard first-line therapy. Conversely, compression stockings should be disregarded in this population, as they are the least efficacious and most unacceptable treatment. Surprisingly, there is no additional benefit of combining therapies.

The clinical assessment of orthostatic hypotension

2010 ◽  
Vol 20 (3) ◽  
pp. 171-182 ◽  
Author(s):  
Karl R Davis
Keyword(s):  
Orthostatic Hypotension ◽  
Cardiovascular Response ◽  
Clinical Importance ◽  
Cardiovascular Responses ◽  
Community Dwelling ◽  
Volume Depletion ◽  
Postural Changes ◽  
Routine Clinical Setting ◽  
Postural Challenge

SummaryOrthostatic hypotension is a common condition seen in up to one-third of community-dwelling and two-thirds of hospitalized older people. It is part of a spectrum of abnormal cardiovascular responses to postural challenge and is associated with syncope, dizziness, falls, volume depletion, drug side-effects and an increased mortality. This article discusses the current classification of orthostatic hypotension and related conditions, and the clinical importance of the control of the cardiovascular response to orthostasis. These are considered with particular reference to the measurement of postural cardiovascular responses in the routine clinical setting. By improving understanding of the methods that are used for assessment of postural changes in blood pressure, clinicians should have greater confidence in the reliability of measurement and in their interpretation.

An Analysis of Systems of Classifying Mild Cognitive Impairment in Older People

2002 ◽  
Vol 36 (1) ◽  
pp. 133-140 ◽  
Author(s):  
Alexander Collie ◽  
Paul Maruff
Keyword(s):  
Cognitive Impairment ◽  
Mild Cognitive Impairment ◽  
Older People ◽  
Classification Systems ◽  
Inclusion Criteria ◽  
Exclusion Criteria ◽  
Genetic Studies ◽  
The Past ◽  
Made In

Objective: Over the past two decades, a number of systems have been developed for the classification of cognitive and behavioural abnormalities in older people, in order that individuals at high risk of developing neurodegenerative disease, particularly Alzheimer's disease, may be identified well before the disease manifests clinically. This article critically examines the inclusion and exclusion criteria of a number of such classification systems, to determine the effect that variations in criterion may have on clinical, behavioural and neuroimaging outcomes reported from older people with mild cognitive impairment. Method: Qualitative review of the literature describing systems of classifying mild cognitive impairment, and outcomes from clinical, behavioural, neuroimaging and genetic studies of older people with mild cognitive impairment. Results: The exclusion and inclusion criteria for these classification systems vary markedly, as do the design of studies upon which the validity of these systems has been assessed. Minor changes to individual exclusion/inclusion criterion may result in substantial changes to estimates of the prevalence and clinical outcome of mild cognitive impairment, while inadequate experimental design may act to confound the interpretation of results. Conclusions: As a result of these factors, accurate and consistent estimates of the outcome of mild cognitive impairments in otherwise healthy older people are yet to be obtained. On the basis of this analysis of the literature, optimal criteria via which accurate classifications of mild cognitive impairment can be made in future are proposed.

scholarly journals MRI evaluation of thalamic volume differentiates MS from common mimics

2017 ◽  
Vol 4 (5) ◽  
pp. e387 ◽  
Author(s):  
Andrew J. Solomon ◽  
Richard Watts ◽  
Blake E. Dewey ◽  
Daniel S. Reich
Keyword(s):  
White Matter ◽  
Three Dimensional ◽  
Assessment Tools ◽  
Class Iii ◽  
Mri Segmentation ◽  
White Matter Abnormalities ◽  
Volumetric Assessment ◽  
Study Participants ◽  
Mri Evaluation

Objective:To determine whether MRI evaluation of thalamic volume differentiates MS from other disorders that cause MRI white matter abnormalities.Methods:There were 40 study participants: 10 participants with MS without additional comorbidities for white matter abnormalities (MS − c); 10 participants with MS with additional comorbidities for white matter abnormalities (MS + c); 10 participants with migraine, MRI white matter abnormalities, and no additional comorbidities for white matter abnormalities (Mig − c); and 10 participants previously incorrectly diagnosed with MS (Misdx). T1-magnetization-prepared rapid gradient-echo and T2-weighted three-dimensional fluid attenuation inversion recovery sequences were acquired on a Phillips Achieva d-Stream 3T MRI, and scans were randomly ordered and de-identified for a blinded reviewer who performed MRI segmentation using LesionTOADS.Results:Mean normalized thalamic volume differed among the 4 cohorts (analysis of variance, p = 0.005) and was smaller in the 20 MS participants compared with the 20 non-MS participants (p < 0.001), smaller in MS − c compared with Mig − c (p = 0.03), and smaller in MS + c compared with Misdx (p = 0.006). The sensitivity and specificity were both 0.75 for diagnosis of MS with a thalamic volume <0.0077.Conclusions:MRI volumetric evaluation of the thalamus, but not other deep gray-matter structures, differentiated MS from other diseases that cause white matter abnormalities and are often mistaken for MS. Evaluation for thalamic atrophy may improve accuracy for diagnosis of MS as an adjunct to additional radiologic criteria. Thalamic volumetric assessment by MRI in larger cohorts of patients undergoing evaluation for MS is needed, along with the development of automated and easily applied volumetric assessment tools for future clinical application.Classification of evidence:This study provides Class III evidence that MRI evaluation of thalamic volume differentiates MS from other diseases that cause white matter abnormalities.

scholarly journals ANALYSIS ON THE PATTERN OF USING THE SERVICE OF REMOVABLE PARTIAL DENTURE MAKING IN A DENTAL LABORATORY IN SURABAYA

2017 ◽  
Vol 52 (4) ◽  
pp. 270
Author(s):  
Okti Setyowati ◽  
Endang Kusdarjanti
Keyword(s):  
Dental Health ◽  
Class Ii ◽  
Class I ◽  
Class Iii ◽  
Removable Partial Denture ◽  
Partial Denture ◽  
Metal Framework ◽  
Removable Denture ◽  
Class Iv

The making of removable denture is performed by a dental laboratory. To facilitate the identification, according to Kennedy classification, classes are divided onto groups, the Kennedy class I, II, III and IV. To suit with the needs of the dental laboratory tasks commonly done, priority are necessary for common cases and should to be taught to students of Dental Health Technology Diploma. In Surabaya, research of various cases of removable partial denture with the various Kennedy classifications has never been done before. This study was to analyze the pattern of service for the removable partial denture manufacture in dental laboratory at Surabaya (2011 – 2013). The research is an observatory analytic. The population is all dental laboratories located around the campus of the Faculty of Dentistry Airlangga University Surabaya. The sample was the whole population is willing to become respondents. Sampling by total sampling. The method of collecting data using secondary data from a dental laboratory in Surabaya from 2011 until 2013. The note is cases removable denture according to the classification of Kennedy that Kennedy Class I, II, III and IV. Also of note kinds of materials used to make the denture base that is heat cured acrylic resins, thermoplastic resins and metals coherent. The data is a compilation table charting the frequency until needed, then analyzed using cross tabulation. Mostly denture type is flexible type and the least is metal framework. Most cases by classification Kennedy is followed by class II class III and class II and more recently is the fourth. In conclusion, in 2011 and 2013 the manufacture of removable partial dentures according to the classification of Kennedy Class III is the most common in both the upper arch and lower jaw, followed by Class II, Class I and Class IV. In 2012 which is the highest grade III followed by class II, class IV and class I. The denture type most used is a flexible denture, followed acrylic denture and the last is the metal framework.

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