From the Research
Abdominal binders for orthostatic hypotension in elderly patients should be applied in the morning before getting out of bed and worn throughout the day during upright activities, rather than only during ambulation, as this approach provides continuous support during daytime activities when orthostatic stress is most likely to occur. The binder should be removed at night when the patient is recumbent. This recommendation is based on the pathophysiology of orthostatic hypotension and the mechanism of action of abdominal binders, which apply external pressure to the abdomen to prevent blood pooling in the splanchnic circulation upon standing, thereby reducing venous capacitance, increasing venous return to the heart, and maintaining cardiac output and blood pressure when upright 1.
For optimal effectiveness, the binder should be approximately 8-12 inches wide and applied from the lower rib cage to the top of the iliac crest, with firm but comfortable tension. Patients should be instructed to apply the binder while still lying down before their first position change of the day, as this prevents initial orthostatic blood pressure drop. The binder can be temporarily loosened during meals if it causes discomfort but should otherwise be worn continuously during waking hours. Skin should be checked regularly for irritation or breakdown, especially in patients with sensory deficits or fragile skin.
Key considerations in the management of orthostatic hypotension include identifying and addressing underlying causes, such as medication-induced hypotension or volume depletion, and implementing non-pharmacological measures like increasing fluid and salt intake, and using venous compression methods 2, 3. Pharmacological treatment, including fludrocortisone, may also be necessary in some cases, although the evidence for its effectiveness is limited and of low certainty 4.
In clinical practice, the management of orthostatic hypotension should prioritize measures that reduce the risk of falls and improve quality of life, while minimizing potential harms and adverse effects. Regular monitoring of blood pressure, orthostatic symptoms, and overall clinical status is essential to adjust the treatment plan as needed and ensure optimal outcomes for elderly patients with orthostatic hypotension.