Orthostatic hypotension is observed in 10 to 20% of all patients aged 65 or over. The elderly is thus at an elevated risk for orthostatic hypotension; however, the relative contributions of normal ageing, of diseases and their respective treatments to its development are unknown. Orthostatic hypotension discovered by chance in a symptomatic or asymptomatic elderly patient has to be considered as risk for falls or syncopes. The most common reversible causes are side effects of various drugs and hypovolemia. Next to a specific therapy of the underlying causes, symptomatic measures are proposed. Pharmacotherapy is limited to patients incapacitated by symptoms.