The number of senior citizens (people over the age of 65) projected to reside in the U.S. in 2030.
The number of senior citizens currently living in the U.S. which represents 16.5% of the population per the U.S. Census Bureau.
The percentage of growth in the senior population during the last decade (2010 to 2019) per the U.S. Census Bureau.
These numbers tell a story specific to the growth of the senior population, a result of post-WWII “boomers” coming of age. And, as one might expect, this population is also characterized by significant heart disease. Looking specifically at hypertension as an indicator of cardiovascular health, statistics show:
- Of men aged 65-74, 66.7% have hypertension and/or are taking medication to control blood pressure. The percentage leaps to 81.5% in men over the age of 75.
- Of women aged 65-74, 74.3% have hypertension and/or are taking medication to control blood pressure. This percentage increases to 86% in women over the age of 75.
Of course, treating hypertension is a clinical priority in seniors as intervention has been shown to reduce both mortality and morbidity. Such treatment quite often involves the use of medications to reduce the burden on the heart. Polypharmacy is an unfortunate norm in individuals with systolic pressure greater than 160 mmHg and/or diastolic pressure greater or equal to 100 mmHg. And with polypharmacy comes an increased risk for adverse events – including falls. When treating seniors for hypertension, physicians are mindful that side effects can occur due to new regimens and when adjusting dosage. Orthostatic hypotension, dizziness, syncopal episodes, and lethargy are examples of common symptoms experienced by individuals taking antihypertensive medications.
Examining drug-induced fall risk in older patients
In a November 2022 study appearing in Frontiers in Pharmacology, researchers Zhou, et al examined 208,849 reported adverse events from the FAERS database for the period from January 2004 to December 2020. Of the reported adverse events examined, 34,840 events involved a fall in older patients (average age 77 years) who were taking 1,898 different medications for a broad cross-section of diseases and conditions.
Per the findings of this study, the drug classes that result in a greater risk for a fall in seniors are drugs used to treat nervous system disorders and hypertension. In patients treated with antihypertensives, a fall can result from a sudden decline in blood pressure that occurs when standing up. The physical response exhibited in orthostatic hypotension is a pooling of the blood in the lower body that results in a transient decline in cardiac output. Orthostatic hypertension is common in 70% of patients being treated for hypertension. The coexistence of orthostatic hypotension and hypertension makes treating these patients particularly difficult, as Italo Bigonni stated “the treatment of one can worsen the other” in a study published in the American Journal of Hypertension.
Monitoring motion health in patients with cardiovascular disorders
Due to the risk of orthostatic hypotension in seniors treated for hypertension, physicians are often required to serially titrate dosing in patients in an effort to minimize the likelihood of an adverse event, with specific concern attributed to increased fall risk. A phased titration approach is highly necessary in polypharmacy regimens required for treating blood pressure and other co-morbidities (i.e. diabetes) common to the patient with increased cardiovascular risk. Introducing new medications and/or titrating existing medications invites greater potential for drug-to-disease and drug-to-drug adverse events.
A comprehensive approach to the management of this population at a high risk for falls can include balance and gait assessment. Asking the patients periodically about their motion health or fear of falls may not be sufficient in this population given the elevated risk and the detrimental effects of a fall. Furthermore, patients can be reluctant to self-report issues related to health status when they believe doing so reveals a decline in health and may jeopardize their independence. For this reason, continuous and objective motion, balance, and gait analysis is critical in these patients. A prompted, routine Timed Up and Go (TUG) test can also be a valuable tool to clinicians responsible for the care of these patients. These assessments can reveal particularly important functional mobility insight following the introduction of a new medication to the patient’s drug regimen or when titrating current medication dosage.
Now with the use of new technology, such as OneStep, providers can gain visibility into how a patient moves during their everyday life and assign functional mobility assessments to perform regularly at home. OneStep offers baseline and longitudinal motion analysis data, enabling providers to catch changes in important gait parameters and functional mobility assessments in real-time, identifying patients who are at an increased risk for falls for proactive interventions. Monitoring mobility as a regular part of health assessments is critical – a vital sign that should not be underestimated.