If I had to recommend one essential piece of healthcare equipment for older adults and their caregivers, it would undoubtedly be this: a reliable home blood pressure (BP) monitor.
Why? Because BP measurements—and pulse readings, which many devices provide simultaneously—are invaluable tools for assessing and improving an older adult’s health and well-being. This holds true even for older adults who aren’t being treated for high blood pressure (hypertension).
To encourage more older adults and families to understand the benefits of home BP monitors, this article will explain how they can be particularly helpful. (For related guidance, see my article: Choosing & Using a Home Blood Pressure Monitor: What to Ask Your Doctor.)
Here are three key ways a home BP monitor can make a meaningful difference in the health of older adults, improving the support clinicians provide in their care.
1. Detecting Serious Health Issues
When an older adult feels unwell, changes in BP or pulse can help a doctor or nurse determine whether a serious medical issue might be present.
Doctors typically focus on two key concerns:
- Heart rates that are significantly higher than normal (especially pulses above 100 beats per minute).
- BP that is notably lower than usual (especially resting systolic BP— the top number—below 100).
If you’re calling a medical advice line, being able to share the older adult’s BP and pulse can lead to more informed guidance. Be sure to also describe how the person seems different from their usual state, such as any new or worsening confusion (a potential sign of delirium).
Having a record of the older person’s typical BP and pulse can be incredibly useful, though not essential. This is why maintaining a BP log is a great practice—especially if you use a monitor that syncs readings to an app or online platform, making it easier to track trends.
2. Reducing Fall Risks by Monitoring Sitting vs. Standing BP
Did you know that many older adults experience a drop in BP when they stand? This condition, known as orthostatic hypotension, is particularly common in those taking medication to lower BP.
For these individuals, a normal sitting BP might drop to a fall-inducing level upon standing.
For older adults who have fallen or had near-falls, it’s crucial to check BP in both sitting and standing positions. This is a standard practice in geriatrics, though not all doctors routinely recommend it.
Here are key points to consider:
- A systolic BP below 110 when standing, or a drop of more than 20 points, may warrant adjustments to medications.
- Certain medications, like those for an enlarged prostate (e.g., tamsulosin, also known as Flomax), can lower standing BP as a side effect.
For more on medications that affect BP and increase fall risks, check out my article: Preventing Falls: 10 Types of Medications to Review if You’re Concerned About Falling.
3. Assessing the Impact of Medication Changes
BP plays a crucial role in how an older adult feels. When medications for BP or heart issues are adjusted, I encourage families to monitor BP at home for 3–7 days afterward. This proactive approach helps doctors find the right dosage more quickly, avoiding the need to wait for a three-month follow-up appointment.
When a medication change is made, ask the doctor these key questions:
- What is the target BP (in a sitting position)?
- At what BP level (e.g., systolic above 150, 170, or 180) should I call for medical advice? The threshold depends on the individual’s health circumstances.
It’s also a good idea to monitor both sitting and standing BP, especially for those with balance issues or a history of falls. Keep in mind that BP can vary slightly throughout the day and between days. Tracking for several days in a row provides more accurate information for clinicians.
A Real-Life Example: How BP Monitoring Made a Difference
Earlier this year, a 91-year-old man with vascular dementia (let’s call him Mr. A) demonstrated the power of home BP monitoring.
Mr. A had previously experienced a transient ischemic attack (TIA or “mini-stroke”), and his doctors wanted to keep his BP low using medication. However, his family noticed he often felt unsteady at home.
By checking his BP both sitting and standing twice daily, they made some important discoveries:
- Mr. A’s standing BP was frequently much lower than his sitting BP, often dropping below 100 systolic.
- Most of the significant drops occurred in the morning, about an hour after he took his morning medications, including a small dose of amlodipine, a once-daily BP medication.
With this information, we decided to split the dose, giving half a tablet twice daily instead of all at once.
The results were encouraging: Mr. A’s morning standing BP improved, and his afternoon BP remained stable. More importantly, he felt steadier and more energetic, and his caregivers noticed he was more willing to move around the house using his walker.
Final Thoughts
A home BP monitor is a valuable tool for older adults, especially for addressing issues like low standing BP, which can lead to falls. It’s particularly helpful to monitor BP in the days following changes to medications for BP or heart conditions.
For older adults who feel well and haven’t had any medication changes, checking BP every 2–4 weeks may suffice.
If you’re already using a home BP monitor, great job! If not, I hope this article inspires you to consider getting one. It can truly help older adults receive better care, whether for managing high BP or providing critical insights during a health concern.
For more information, see my related article: Choosing & Using a Home Blood Pressure Monitor: What to Ask Your Doctor.
