What causes postural hypotension in older adults?

Standing requires blood vessels to tighten so blood continues reaching the brain. With age, this automatic adjustment may be slower, while thirst may be less noticeable and the body may hold less fluid. Hot weather, poor intake, diarrhoea, vomiting or infection can therefore trigger symptoms. Water tablets, blood-pressure medicines, medicines for Parkinson’s disease and some sedating medicines may add to the effect. Diabetes, heart problems, anaemia and nerve conditions can also contribute. The result may be dizziness, blurred vision, weakness, unsteadiness or a fall soon after standing.

Encourage a slow sequence: wake, sit, move the feet, pause, then stand with support. Keep pathways clear and use prescribed walking aids. Fluids may help when medically suitable, but people with heart or kidney conditions should ask about their safe intake. Review every medicine with a GP or pharmacist, including non-prescription products, and never remove a dose independently. Record symptoms, falls, meals, drinks and medicine times. A clinician can compare blood pressure lying and standing and look for a treatable trigger.

Seek prompt advice after repeated near-fainting, a fall, new confusion, or a noticeable change in walking or alertness. Emergency help is needed for fainting with chest pain, severe breathing difficulty, a serious injury, one-sided weakness, speech trouble, or failure to recover normally. While waiting, help the person lie flat or sit safely, and do not let them walk alone. A new or worsening pattern deserves assessment even when symptoms settle quickly.

Could a medicine, infection, dehydration or anaemia be contributing? Is the person safe to increase fluids? Should we check blood pressure in different positions, review fall risk, or arrange heart and blood tests?