About Physiatry


Condition: Orthostasis or orthostatic hypotension is a decrease in blood pressure that happens soon after standing.

Background: Orthostatic hypotension occurs in approximately 20% of people 65 and older. Thirty percent of fainting episodes in the elderly are due to orthostasis.

Risk Factors: The most important risk factor for orthostatic hypotension is age. People who take blood pressure or heart disease medications are also at risk.

History and Symptoms: Orthostasis often causes lightheadedness, dizziness and fainting, which in turn leads to falls and injuries. When a person stands upright, gravity causes the blood to pool in the legs. This reduces blood pressure since less blood is circulating back to the heart to pump.

Physical Exam: A physician typically checks the patient’s blood pressure and heart rate while he or she is lying down, sitting, and standing. Physicians also assess for conditions such as Parkinson's disease, cognitive impairment, depression and stroke.

Diagnostic Process: After a physical exam, if the physician is still unsure if a patient has orthostatic hypotension, he or she may order blood tests or an electrocardiogram (ECG).

Rehab Management: The first step is to take active preventive measures to avoid orthostatic hypotension, such as avoiding dehydration. Patients can also take steps to improve circulation before standing, such as flexing their feet. Waist high compression stockings can help, as well as abdominal binders, which are garments that support abdominal muscles.

Other Resources for Patients and Families: Patients and caregivers should understand what is causing the orthostasis, and make changes so the issue is resolved or improved, such as exercising the legs before standing. Making sure any adverse effects from medication, such as dizziness, are managed is important, too. Support stockings or garments should always be removed when lying down.


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