What is Orthostatic Hypotension?Orthostatic hypotension (also known as postural hypotension) is a sudden drop in blood pressure that often occurs when someone gets up from a lying down or sitting position. The term “orthostatic” means an upright posture, and “hypotension” is the medical term for low blood pressure. The clinical definition of this orthostatic hypotension is when standing or sitting up causes blood pressure to drop more than 20 in systolic (top) and 10 in diastolic (bottom) pressure. So if blood pressure is dropping from 120/80 to 100/70 after standing up, this would be considered orthostatic hypotension. When a person sits or lies down, blood collects or pools in the legs or lower body. When a person gets up from this lying down position, the collection of blood in the legs means that there is less blood available to circulate to the heart and brain. This happens in people of all ages. In a normal, healthy person, specialized cells near the heart (baroreceptors) automatically sense this lowered blood pressure when standing up. In response, the baroreceptors are supposed to signal the person’s heart to pump faster and stabilize blood pressure. Orthostatic hypotension happens when this natural process of counteracting lowered blood pressure when standing up does not function properly. In a person with orthostatic hypotension, the baroreceptors do not trigger the appropriate response to counteract the low pressure when standing.
What Causes Orthostatic Hypotension?Chronic orthostatic low blood pressure is a condition commonly associated with old age. However, many conditions are known to cause or contribute to orthostatic hypotension including:
- Dehydration: dehydration reduces overall blood volume, which can contribute or cause orthostatic hypotension.
- Cardiovascular Problems: a number of different heart problems can cause low blood pressure and prevent the body from responding properly when standing up.
- Endocrine Problems: certain thyroid conditions such as adrenal insufficiency and hypoglycemia can trigger orthostatic hypotension. Diabetes can also be a cause because it can impair the nerves that help regulate blood pressure.
Orthostatic Hypotension in Elderly Nursing Home ResidentsElderly people in nursing homes are at particularly high risk for orthostatic hypotension. Specialized cells near the heart and neck called baroreceptors are supposed to signal the heart to speed up in response to low blood pressure when standing up. However, as a person ages, the effectiveness of these baroreceptor cells rapidly deteriorates (in some people faster than others). As a result, when many elderly people get up from lying down, their body is not getting the proper signals to counteract the lowered blood pressure. This problem is compounded by the fact that elderly people are also more prone to have all the other conditions that are known to contribute to orthostatic hypotension (diabetes, cardiovascular problems, etc.).
Orthostatic Blood Pressure Can Cause Nursing Home Residents to FallIt is well known that elderly people, especially elderly nursing home residents, are at very high risk for chronic orthostatic hypotension. A study published in the American Journal of Medicine in 2016 revealed that orthostatic hypotension is a major underlying cause of recurrent falls among elderly nursing home residents. The study looked at data from 844 elderly residents at 40 long-term nursing care facilities. The study found that elderly residents diagnosed with orthostatic hypotension were 3 to 4 times more likely to fall compared to residents with normal orthostatic blood pressure. Based on these results, the researchers strongly urged nursing home facilities to recognize orthostatic hypotension as a major risk factor for recurrent falls. The study also recommended that screening and treatment for orthostatic hypotension be instituted as precautionary measures just like bed rails and other safety measures.
Nursing Home Negligence Related to Low Blood PressureThe study establishing the link between orthostatic blood pressure and falls among nursing home residents is significant because it arguably establishes a new standard of care for nursing homes. In light of this study, nursing home facilities need to have measures in place to identify residents with orthostatic hypotension and treat them as “high risk” fall patients. If a nursing home or elder care facility does not make any effort to screen for orthostatic hypotension, and/or take other appropriate precautionary measures to prevent falls they could be liable for negligence or malpractice.
Low Blood Pressure-related Negligence Verdicts and Settlements
YEAR / STATE
CASE / INJURY SUMMARY
2011 – Pennsylvania
A woman returned home after undergoing dialysis. She fell outside her home after exiting the medical transport sedan. The woman suffered ankle and left leg fractures. She underwent a below-the-knee amputation and remained hospitalized for three months. The woman received a prosthetic leg and was now wheelchair-bound. She alleged that the medical transport company staff’s failure to properly assist her with exiting the vehicle caused her permanent injuries. The woman claimed they failed to consider that her pre-existing orthostatic hypotension made her a fall risk. The defense denied liability by disputing whether the fall directly caused her injuries. Following two mediations, the parties agreed to a $2,800,000 settlement.
$2,800,000 – Settlement