Vitamin D and orthostatic hypotension

K. G. McCarroll et al. Age and Ageing 2012; 41: 810–813 doi: 10.1093/ageing/afs088 Published electronically 11 July 2012 Key points • In the UK there are 38.3 million Internet users representing 77% of the population. • Websites offer an easy way of disseminating information both to other health-care professionals and patients. • In our survey, the likelihood of never using the Internet increased with age from 5% for ages of 4–49 to 45% for ages of 80 and over. • Seventy-two per cent of patients in the age range 60–69 and 55% of over-80 year olds do have the Internet at home. • All departments should look at their web presence and consider someone as a web editor/web lead for that area. Conflicts of interest None declared. Supplementary data Supplementary data mentioned in the text is available to subscribers in Age and Ageing online. References 1. Office for National Statistics. Statistical Bulletin. Internet Access 2010. 2. Internet Access 2010. Statistical Bulletin from the Office for National Statistics (http://www.statistics.gov.uk/pdfdir/iahi0810.pdf ). 3. Garthwaite M, Bultitude MF. Urology NHS WebPages: a review of English NHS Trusts. BJMSU 2011; 4: 182–6. 4. Office for National Statistics. Statistical Bulletin. Internet Access 2011. Received 16 November 2011; accepted in revised form 30 May 2012 © The Author 2012. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For Permissions, please email: Vitamin D and orthostatic hypotension KEVIN GERALD MCCARROLL1,2, DAVID J. ROBINSON3, AVRIL COUGHLAN4, MARTIN HEALY5, ROSE ANNE KENNY6, CONAL CUNNINGHAM3 1 Department of Gerontology, St James’s Hospital, James’s St, Dublin D8, Ireland Mercers’s Institute for Research on Ageing, Hospital 4, Top Floor, St James’s Hospital, James’s St, Dublin D8, Ireland 3 Department of Gerontology, St James’s Hospital, Dublin D8, Ireland 4 Department of Physiology, Trinity College, Dublin, Ireland 5 Department of Biochemistry, St James’s Hospital, Dublin D8, Ireland 6 Department of Gerontology, Trinity College, Dublin, Ireland 2 Address correspondence to: K. G. McCarroll. Email: 810 that reduce the need for a mouse—designed to aid arthritis sufferers—allowing the webpage to be controlled by the keyboard alone. High-visibility keyboards may also be useful for the visually impaired. A cheaper alternative is to purchase high-visiblilty stickers which can be attached to an existing standard keyboard (for examples of the BrowseAloud interface and magnifying application, see Figures 4–6 in Appendix 1 in the Supplementary data available in Age and Ageing online). In a recent survey conducted by the ONS in 2011, individuals were asked why they did not own an Internet connection within their home. The most common response by 50% said they did not need it, but 21% said a lack of skills prevented them from having it [4]. This is likely to be very prevalent in the older population. To encourage computer literacy, Age UK organises promotional weeks with events nationwide to help older people develop IT skills (http:// www.ageuk.org.uk/work-and-learning/technology-andinternet/events/). They organise the delightfully titled ‘itea and biscuits week’ to help people learn about computers and modern technology and also ‘myfriends online week’ to help teach about the social side of the Internet. Although there are a number of books designed to teach older people basic computer skills, it seems a paradox that most IT courses are advertised online. This may be useful if friends or family can help but is of no use to someone starting off using a computer. Maybe GP practices and elderly care departments could offer these services. In conclusion, although lower than other age groups, Internet use is common among the over-65’s and this will only increase in the future. As a group they are interested in health information and we should ensure that we not only have suitable content for them but also ensure our websites are accessible and readable. Vitamin D and orthostatic hypotension Abstract Keywords: vitamin D, orthostatic hypotension, orthostatic haemodynamics, older people Orthostatic hypotension (OH) is common in the elderly and is associated with falls, fractures and significant morbidity and mortality [1]. Vitamin D supplementation has been shown to reduce risk of falls that may be mediated by it’s effect on muscle strength and balance [2–4]. However, other potential mechanisms for this fall reduction are unclear. It is possible that vitamin D may also play a role in orthostatic hypotension, though evidence is lacking. Vitamin D has been implicated in both systolic and diastolic blood pressure, as well cardiovascular and cerebrovascular disease [5–9]. Vitamin D receptors are found in vascular smooth muscle, endothelial and cardiac cells suggesting that vitamin D could affect vasomotor and cardiac response during orthostasis [10]. We aimed to investigate the hypothesis that lower vitamin D status is associated with orthostatic hypotension in a case–control model involving community-dwelling older adults. Methods All participants were community-dwelling adults who were not taking vitamin D supplements. Cases were subjects aged 64 or older who were diagnosed with orthostatic hypotension at the Falls and Blackout Unit at St James’s Hospital, Dublin and were consecutively recruited between January and February 2009. Those unwilling or unable to give consent or who had an illness in the past month were excluded. Controls were age- (within 5 years) and gender-matched subjects who had no history of blackouts, falls or orthostatic dizziness in the preceding year and who were participants of the Dublin Healthy Ageing Study (DHAS), details of which have been previously described [11]. This is a community-based study examining physical, psychiatric, cognitive and social health care characteristics of nondemented older people. Subjects in the DHAS who met our criteria were randomly selected from this study database. Blood samples and clinical data from the DHAS were used for comparison with the OH group who attended the Falls and Blackout Unit. Assessments Orthostatic hypotension was diagnosed with the use of an active stand test and was defined according to the consensus criteria as a reduction in systolic or diastolic blood pressure of ≥20 and 10 mmHg respectively, within 3 min of assuming an erect posture [12]. The active stand test involves measuring haemodynamic variables while the patient moved from a horizontal to a standing position with or without assistance. Noninvasive continuous plethysmographic measurements of beat-to-beat blood pressure and heart rate were recorded with the use of a standardized device (Finometer®). This converts finger arterial pressures to brachial arterial pressures by a method of brachial reconstruction. Measurements were taken after lying supine for 5 min and then on standing up quickly and continuing to stand for 3 m (...truncated)