Strategies for Non-Pharmacological Management of Orthostatic Hypotension in Older People: Bridging Pathophysiology and Practice

This review examines the effectiveness of non-pharmacological interventions for managing orthostatic hypotension (OH), a condition prevalent among older adults. Current guidelines prioritise non-pharmacological methods such as physical counter-manoeuvres and compression garments as first-line treatments for OH. Conducting a comprehensive medication review to identify potentially causative agents, along with patient education, is highlighted as essential for optimising the efficacy of non-pharmacological interventions. The review addresses the potential pathophysiological underpinnings of OH, identifying neuro cardiovascular control, vascular insufficiency and the effects of ageing as key treatment considerations. Additionally, it highlights the importance of patient-specific factors, emphasising the strengths of individualised treatment plans. Limitations, including the challenges of heterogeneity in OH, patient adherence and inter-individual variability are discussed, alongside future research needs aimed at optimising these strategies. Effectively managing OH with accessible, cost-effective and low-risk non-pharmacological methods could benefit individuals with OH and help meet the growing healthcare demands of an ageing population.