ArticleGeroScience2023
Applying systems thinking to unravel the mechanisms underlying orthostatic hypotension related fall risk.
Article in GeroScience, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 1 of them a synthesis that pooled it.
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Who cites it
7 citing papers in PubMed, 1 synthesis or guideline pooled it, 11 citations in OpenAlex.
- Prevalence and incidence of orthostatic hypotension in patients with Parkinson's disease: an updated systematic review and meta-analysis.Frontiers in neurologyPooled it
- Unmasking orthostatic hypotension after cellular therapy: risk factors, implications, and clinical significance.Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer · 2026Article
- A Closed-Loop Cardiovascular Model of the Supine-To-Stand Manoeuvre: Implications for Falls.International journal for numerical methods in biomedical engineering · 2026Article
- Diagrams-to-Dynamics (D2D): Exploring causal loop diagram leverage points under uncertainty.BMC medicine · 2026Article
- Age-Related Alterations of Cerebral Autoregulation.Life (Basel, Switzerland) · 2025Review
- Prognostic Implications of Orthostatic Hypotension in Elective Coronary Artery Bypass Grafting.Medical science monitor : international medical journal of experimental and clinical research · 2025Observational
- Using network analysis to identify leverage points based on causal loop diagrams leads to false inference.Scientific reports · 2023Article
Corrections and comments
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Authors and funding
16 authors at 9 institutions in 3 countries.
Funding
No grant is acknowledged in the PubMed record.
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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