Prevalence and screening of orthostatic hypotension in older adults presenting to the emergency department: A systematic review

Background:
Orthostatic hypotension (OH) affects up to one in five older adults, yet its prevalence and screening practices in emergency departments (EDs) remain poorly characterised. This systematic review synthesised evidence on OH prevalence, screening rates, and clinical outcomes among older adults presenting to the ED.

Methods:
Four databases were searched on 9 July 2025, no date restrictions were applied. Studies involving adults aged ≥ 65 years presenting to the ED reporting OH prevalence or screening rates were included. Methodological quality was assessed using Joanna Briggs Institute critical appraisal tools.

Results:
Six studies encompassing 2543 older adults presenting to the ED with falls, syncope, or dizziness across five countries met inclusion criteria. OH screening rates varied from 5 to 100% and prevalence ranged from 5 to 42%. Secondary outcomes included hospital admission rates (26–48%), traumatic complications (16–37%), and associations with Parkinson’s disease and cardiovascular medications. Intra-ED mortality was less than 1% in one study; 24-month mortality was 11% in a separate syncope cohort.

Conclusion:
Findings reveal gaps between clinical guidelines recommending routine OH screening in at-risk populations and current practice. Elevated OH prevalence among both falls and syncope presentations supports targeted, risk-stratified screening approaches. Quality improvement initiatives and implementation research may improve outcomes for older adults presenting to the ED.