Reviews in Clinical Gerontology

Clinical geriatrics

Autonomic dysfunction in older people

J Richard G Marigolda1 c1, Monica Ariasa2, Michael Vassalloa1a2, Stephen C. Allena1a2 and Joseph SK Kwana1

a1 Department of Medicine for Older People, Royal Bournemouth Hospital

a2 School of Health and Social Care, Bournemouth University, UK


The autonomic nervous system comprises the sympathetic, parasympathetic and enteric nervous systems and plays an integral role in homeostasis. This includes cardiovascular and temperature control, glucose metabolism, gastrointestinal and reproductive function and increasing evidence to support its involvement in the inflammatory response to infection and cancer. Ageing is associated with autonomic dysfunction, and many clinical syndromes associated with older adults are due to inadequate autonomic responses to physiological stressors. The aim of this review is to explore the relationship between autonomic dysfunction and ageing illustrated with examples of maladaptive autonomic responses in a variety of different clinical syndromes including an exploration of autonomic cellular changes. Appropriate investigation and management strategies are outlined, recognizing the fine balance needed to improve symptoms without creating further medical complications.

(Online publication October 15 2010)


c1 Address for correspondence: Dr J Richard G Marigold, Department of Medicine for Older People, Royal Bournemouth Hospital, Castle Lane East, Bournemouth BH7 7DW, UK. Email: