Sunday 11 August 2013

Elderly care services showing worst decline in Labour-run poor boroughs

Biggest spending falls in deprived areas reflect coalition's town-hall budget cuts, says Labour Labour-run councils in some of England's poorest areas have cut services for vulnerable older people far more deeply than Conservative authorities during the coalition's time in power, new research finds. Despite rising demand for assistance, linked to the ageing population, every one of the 152 local ...

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The prevalence and pathological correlates of orthostatic hypotension and its subtypes when measured using beat-to-beat technology in a sample of older adults living in the community

Background: beat-to-beat technology is increasingly used for investigating orthostatic intolerance (OI) but the prevalence of orthostatic hypotension (OH) diagnosed with this technology is unclear.

Objectives: (i) to use beat-to-beat technology to define the prevalence of OH, (ii) to investigate the pathological correlates of OH, (iii) to report the diversity of postural BP responses.

Methods: cross-sectional study of adults ≥ 65 years. BP responses to a 3-min head-up tilt were analysed.

Results: of 326 participants, 203(62.3%) were females. The median (IQR) age was 73 (70–78). One hundred and ninety-one (58.6%) met standard (20 mmHg systolic/10 mmHg diastolic) criteria for OH. The prevalence was higher in females (60.1% F versus 56.1% M); 47% were arteriolar subtype, 33% were venular, 9% were mixed and 11.0% could not be classified. Morphological analysis identified 102 subjects with ‘small drop, overshoot’, 131 with ‘medium drop, slow recovery’ and 31 with ‘large drop, nonrecovery’. Those with OH had a lower BMI (P = 0.02), a higher resting heart rate (P = 0.005), were more likely to take a psychotropic (P = 0.02), have vertigo (P = 0.004) and report OI (P = 0.02). The 95th centile for the duration of systolic BP (SYSBP) decay >20 mmHg was 175 s and the slope of systolic BP decay was 4.75 mmHg/s. The 5th centile for percentage recovery of SYSBP was 81.4%.

Conclusion: (i) beat-to-beat methods identify a higher prevalence of OH than sphygmomanometry, (ii) the pathological correlates of OH diagnosed in this manner are similar to those described for sphygmomanometry, (iii) there is a diverse pattern of orthostatic BP decay that could be used in future research to predict adverse outcomes in OH.

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