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Wang L, Pronk AC, van Poelgeest EP, Briggs R, Claassen JAHR, Jansen S, Klop M, de Lange FJ, Meskers CCGM, Odekerken VJJ, Payne SJ, Trappenburg MC, Thijs RD, Uleman JF, Hoekstra AG, van der Velde N. Applying systems thinking to unravel the mechanisms underlying orthostatic hypotension related fall risk. GeroScience 2023; 45:2743-2755. [PMID: 37115348 PMCID: PMC10651607 DOI: 10.1007/s11357-023-00802-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 04/17/2023] [Indexed: 04/29/2023] Open
Abstract
Orthostatic hypotension (OH) is an established and common cardiovascular risk factor for falls. An in-depth understanding of the various interacting pathophysiological pathways contributing to OH-related falls is essential to guide improvements in diagnostic and treatment opportunities. We applied systems thinking to multidisciplinary map out causal mechanisms and risk factors. For this, we used group model building (GMB) to develop a causal loop diagram (CLD). The GMB was based on the input of experts from multiple domains related to OH and falls and all proposed mechanisms were supported by scientific literature. Our CLD is a conceptual representation of factors involved in OH-related falls, and their interrelatedness. Network analysis and feedback loops were applied to analyze and interpret the CLD, and quantitatively summarize the function and relative importance of the variables. Our CLD contains 50 variables distributed over three intrinsic domains (cerebral, cardiovascular, and musculoskeletal), and an extrinsic domain (e.g., medications). Between the variables, 181 connections and 65 feedback loops were identified. Decreased cerebral blood flow, low blood pressure, impaired baroreflex activity, and physical inactivity were identified as key factors involved in OH-related falls, based on their high centralities. Our CLD reflects the multifactorial pathophysiology of OH-related falls. It enables us to identify key elements, suggesting their potential for new diagnostic and treatment approaches in fall prevention. The interactive online CLD renders it suitable for both research and educational purposes and this CLD is the first step in the development of a computational model for simulating the effects of risk factors on falls.
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Affiliation(s)
- Liping Wang
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Geriatrics, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Anouschka C Pronk
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Geriatrics, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
| | - Eveline P van Poelgeest
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Geriatrics, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands.
| | - Robert Briggs
- The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland
| | - Jurgen A H R Claassen
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Sofie Jansen
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Geriatrics, Meibergdreef 9, Amsterdam, The Netherlands
| | - Marjolein Klop
- Department of Biophysics, Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Frederik J de Lange
- Amsterdam UMC location University of Amsterdam, Cardiology and Cardiothoracic Surgery, Meibergdreef 9, Amsterdam, The Netherlands
| | - Carel C G M Meskers
- Amsterdam UMC location Vrije Universiteit Amsterdam, Rehabilitation Medicine, De Boelelaan, 1117, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Amsterdam, The Netherlands
| | - Vincent J J Odekerken
- Amsterdam UMC location University of Amsterdam, Neurology, Meibergdreef 9, Amsterdam, The Netherlands
| | - Stephen J Payne
- Institute of Applied Mechanics, National Taiwan University, Taipei, Taiwan
| | | | - Roland D Thijs
- Department of Neurology, Leiden University Medical Centre, Leiden, The Netherlands
- Stichting Epilepsie Instellingen Nederland (SEIN), Heemstede, The Netherlands
| | - Jeroen F Uleman
- Department of Geriatric Medicine, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, The Netherlands
- Institute for Advanced Study, Amsterdam, The Netherlands
| | - Alfons G Hoekstra
- Computational Science Lab, Informatics Institute, Faculty of Science, University of Amsterdam, Amsterdam, The Netherlands
| | - Nathalie van der Velde
- Amsterdam UMC location University of Amsterdam, Internal Medicine, Geriatrics, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging and Later Life, Amsterdam, The Netherlands
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