Background:​ Orthostatic hypotension (OH) refers to a significant decline in blood pressure that occurs upon assuming an upright posture and represents an intrinsic risk factor for falls in older adults.

Methods:​ Beat-to-beat blood pressure and cerebral blood flow velocity responses were assessed during a passive seated orthostatic stress test (PSOST). In healthy controls, PSOST responses were compared to head up tilt (the ‘gold-standard’). In a cohort of long-term care residents, data from PSOST were compared to falling history.

Results:​ Hemodynamic and cerebrovascular responses were similar between head up tilt and PSOST in healthy controls, except for the delayed systolic blood pressure decline. Older adult fallers had greater delayed systolic blood pressure declines and maximum cerebral blood flow velocity declines compared to non-fallers.

Conclusions:​ PSOST may be a good surrogate for head up tilt in some population groups. We identified novel cardiovascular differences for falling risk in long-term care residents.