Age Ageing. 2026 Jan 3;55(1):afaf379. doi: 10.1093/ageing/afaf379.
ABSTRACT
BACKGROUND: Falls are a major health concern for older adults, affecting one-third of those over 65 years annually, with 10%-20% leading to injury or hospitalisation. Whilst falls are often multifactorial, unexplained falls may overlap with syncope. Orthostatic hypotension (OH), characterised by a significant drop in blood pressure (BP) upon standing, is a potent falls risk factor, likely due to cerebral hypoperfusion. While the association between OH and falls is well established, few studies have examined the combined role of OH and real-time cerebral perfusion measures in predicting future unexplained falls.
METHODS: Frontal lobe cerebral oxygenation (Tissue Saturation Index, TSI) was measured using near-infrared spectroscopy alongside continuous beat-to-beat BP monitoring (Finometer) during active standing in 2478 participants (≥55 years) from Wave 3 of The Irish Longitudinal Study on Ageing. OH was defined as a sustained SBP drop ≥20 mmHg and/or DBP drop ≥10 mmHg at 30, 60 or 90 seconds post-standing. A TSI drop ≥75th centile at 30 seconds was classified as 'greater TSI drop.' Associations between TSI change and OH were analysed using multilevel mixed-effects regression, and longitudinal relationships with unexplained falls were assessed over four years.
RESULTS: One-fifth of participants had OH, associated with older age and cardiovascular disease. OH was associated with significantly greater TSI change from baseline at 30, 60 and 90 seconds (p < .001) in adjusted models. The combination of OH and greater TSI drops predicted future unexplained falls (OR 2.16, p = .003), whereas OH and lower TSI drops did not (OR 1.25, p = .288).
CONCLUSION: The risk of falls associated with OH appears to be modified by the extent of cerebral hypoperfusion upon standing. These findings suggest that integrating cerebral perfusion measures with OH assessment may help refine risk stratification in older adults, particularly for unexplained falls.
PMID:41579034 | DOI:10.1093/ageing/afaf379