Does Reviewing Lying and Standing Blood Pressure in Patients Referred to the Acute Frailty Team Impact Hospital Admissions?

Introduction

Falls in older adults are multifactorial, with orthostatic hypotension recognised as a key modifiable risk factor. Lying and standing blood pressure (LSBP) measurement is used to identify this. This study aimed to assess whether LSBP assessment in patients reviewed by the acute frailty team prompted medication optimisation and reduced fall-related hospital readmissions over 12 months.

Methods

A retrospective study was conducted at a district general hospital involving patients reviewed by the acute frailty team between 2023-2024. A total of 2,631 patients with Clinical Frailty Scores (CFS) of 4–7 were assessed.  677 presented with falls. Patients discharged directly from the emergency department (ED) and referred to the virtual frailty ward were identified and analysed.

Results

Following review from the frailty team, 36.4% of patients presenting with a fall were discharged from ED, with 12.6% referred to the virtual frailty ward for blood pressure review and medication optimisation. LSBP measurements were recorded in 65% of these patients, with 68% of patients found to meet criteria for postural hypotension. Medication changes were made for all these patients.  69% of patients who had a medication change due to an identified postural hypotension represented to the emergency department within 12 months with 77% of patients reattending due to a further fall.

Conclusion

Review in ED by an acute frailty team reduces admission bias for patients with falls. LSBP measurement is a useful diagnostic tool for identifying orthostatic hypotension in frail older adults. However, high re-presentation rates suggest that LSBP assessment and medication optimisation alone are insufficient to prevent recurrent falls. This study challenges the utility of conducting LSBP. This has potential implications on future falls and nursing assessments with the opportunity to streamline and focus on more effective tools.  A multidisciplinary approach addressing multiple contributing factors is essential to reduce fall-related hospital admissions.