Non-pharmacological management of orthostatic hypotension in the elderly patient

In conclusion, there are many non-pharmacological therapies for OH with good scientific plausibility and a respectable evidence base for effectiveness. Most are inexpensive and free of significant side-effects. On the other hand, they require time and motivation on behalf of both patient and physician and this has limited their use to date. Care with both individualization of treatment and patient selection is required. Most evidence so far has been in younger patients, but there is no reason why most would not be equally effective in older patients, who are frequently more compliant of therapies in any case. More research is required in order to establish the most appropriate and acceptable methods for older patients and more time-effective ways for busy clinicians to impart training (e.g. information leaflets and videos versus group or individualized instruction). In the interim, we recommend that non-pharmacological therapies be considered in all patients with symptomatic orthostatic hypotension before medication is instituted, and as an adjunct for patients who are not adequately controlled using medication. © 2006 Cambridge University Press.