Older peoples’ perspectives of postural hypotension in general practice: a qualitative study

Background Postural hypotension (PH) affects 20-30% of community-dwelling older adults, but largely under-recorded in general practice. An important contributor to under-detection of PH is a lack of symptoms, awareness of symptoms and patient under-reporting.

Aim To explore older peoples’ perceptions and experiences of PH

Design & setting Qualitative interview study with older adults living in urban or rural areas of England.

Method One-to-one semi-structured interviews with older people aged ≥65 years who either had a diagnosis of PH or were identified as at high-risk of PH. Participants were recruited through general practices in London and Devon. Interviews were audio-recorded, transcribed verbatim and analysed thematically.

Results We interviewed 23 older participants aged 65-95 years, including 15 interviews in London and eight in Devon, of which 10 had a coded diagnosis of PH. Overall, there was poor awareness and understanding of PH, regardless of diagnosis status. Many who sought help reported their symptoms were often dismissed, misattributed or normalised as ageing. Continuity in general practice and contacts in secondary care facilitated diagnosis of PH. Numerous barriers to care were reported. Older people at the intersection of multiple factors (eg, older age, geographical location) experienced greater barriers to diagnosis and care.

Conclusions This is the first study to explore older peoples’ perspectives on PH diagnosis. Findings suggest changes to raise the profile of PH in general practice is required, including increasing awareness through health promotion and tailored approaches in high-risk individuals.