Every day in the hospital I see people who have had a fall and often the reason is a condition called postural hypotension (also known as orthostatic hypotension).
Hypotension simply means low blood pressure. The postural bit refers to the fact that the low blood pressure is a problem when you stand up. It affects up to 30 per cent of adults over 65 and significantly increases your risk of having a fall.
If you have postural hypotension you’ll find that when you’re sitting or lying down, your blood pressure is high enough to pump sufficient blood and essential oxygen up to your brain. But as you stand up your blood pressure drops, typically by at least 20 mmHg systolic and 10 mmHg diastolic, and often much more. This usually happens within minutes of standing upright. You may become dizzy or lightheaded and may briefly lose consciousness and fall to the floor.
Other symptoms include weakness, fatigue, lethargy, palpitations, sweating and visual and hearing disturbances. But not everyone has symptoms and postural hypotension often isn’t discovered until you’re admitted to hospital following a fall.
A number of things contribute to it. When you stand up, gravity causes blood to ‘pool’ in your leg veins, so there is less being sent to your brain.
Normally your nervous system makes adjustments to counteract this by constricting the blood vessels in your legs or increasing your pulse rate. But as you get older your body finds it harder to control your circulation and stop this happening.
You can try to manage the condition yourself by getting up slowly and rest if you feel lightheaded. Stay well-hydrated and have a glass of water in the morning before getting out of bed.
If you’re worried your GP or practice nurse can check your blood pressure while sitting and then at one minute and three minutes after standing. They may recommend wearing compression stockings to help stop blood pooling in your veins. However, it’s vital that you have a test to measure the pressure of blood in the arteries first – if your circulation is poor, compression stockings may cut blood flow to dangerous levels.
Your doctor will also check your medication to see if that is part of the problem, because drugs such as diuretics (water tablets) and prostate medication could increase your risk of postural hypotension.
Q. I’m having radiotherapy for breast cancer. I live alone and the treatment’s making me so weak that I don’t have the energy to drive to my appointments. What can I do?
Dr Trisha says: It’s vital you get the best chance of beating the disease by sticking to your treatment schedule. The hospital will be quite used to this problem as many people undergoing radiotherapy are in the same situation. Talk to the clinic – they may be able to organise transport for you either through the outpatient ambulance service or their own volunteers.
In some areas local charities operate a volunteer driver service too. Don’t forget friends or local groups such as the church. Although it’s difficult to ask for help, you will find that many people are keen to do what they can. For help managing fatigue, or if feeling isolated by your illness, Macmillan Cancer Support are a great resource (0808 808 0000, www.macmillan.org.uk)