Interesting cited study, here, where researchers used the Good Palliative-Geriatric Practice Algorithm to reduce the numbers of drugs a group of elderly people were on, thus significantly improving their well-being as a result. Page 2 of the study has the algorithm, but the problem in practice would be knowing the actual evidence base for each drug in each age group.
And we’ve all heard of postural hypotension, but there is a much lesser-known and potentially highly disabling problem called postural tachycardia syndrome. For reasons that are unclear, the autonomic nervous system does not respond appropriately to the descent of blood from thorax to abdomen/limbs (approximately half a litre) that occurs on standing. Normally, peripheral vasoconstriction and an increase in heart rate of 10 – 20 bpm compensate adequately, with minimal BP change, but in PoTS the vasoconstriction doesn’t seem to work properly, or at least that’s thought to be what happens; in any case, the blood pools in the splanchnic and peripheral vasculature, causing further increase of heart rate and catecholamine levels in attempted compensation. This may keep the blood pressure normal (or even raised, further confusing the issue), but leaves the brain underperfused, with consequent dizziness and syncope.
There are ways of treating this condition. And I wish I’d known about it three years ago, because I’ve got the uneasy feeling that this fits what I can remember about that patient in whom I never could figure out what on earth was going on… I hope I can track down her records and check.