Skip to main content
NCBI home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 1997 Oct;73(864):635–639. doi: 10.1136/pgmj.73.864.635

The overlap between syncope and falls in the elderly.

F E Shaw 1, R A Kenny 1
PMCID: PMC2431481  PMID: 9497972

Abstract

Syncope and falls are often considered to be two separate diagnoses with two separate sets of aetiologies. However, although it remains controversial, the existence of an overlap between syncope and falls is becoming increasingly acknowledged. In the elderly, determining the cause of a fall can be difficult. Approximately 30% of cognitively normal elderly people are unable to recall documented falls three months later and a witness account for syncopal events is unavailable in about 50% of patients. We have found that in almost 40% of patients in whom an attributable diagnosis of carotid sinus syndrome was made, the only presenting symptoms were falls alone or falls with dizziness; syncope was denied. Amnesia for loss of consciousness can be demonstrated in over 20% of all patients with a diagnosis of carotid sinus syndrome and in 50% of those patients who present only with falls or falls and dizziness. There is a suggestion from studies in postprandial hypotension and orthostatic hypotension, where similar haemodynamic changes are found in patients complaining of either syncope or falls, that this phenomenon may be generalisable. The importance of the presence of an overlap between syndrome and falls in the elderly lies in the healthcare implications of missed diagnoses of cardiovascular syncope for which there are established effective treatments. Consideration of syncope in the differential diagnosis of unexplained falls should reduce the numbers of falls for which no attributable diagnosis is found and result in an improved standard of health care for elderly patients who fall.

Full text

PDF
635

Images in this article

639Figure
on p.639

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aronow W. S., Ahn C. Postprandial hypotension in 499 elderly persons in a long-term health care facility. J Am Geriatr Soc. 1994 Sep;42(9):930–932. doi: 10.1111/j.1532-5415.1994.tb06582.x. [DOI] [PubMed] [Google Scholar]
  2. Brignole M., Oddone D., Cogorno S., Menozzi C., Gianfranchi L., Bertulla A. Long-term outcome in symptomatic carotid sinus hypersensitivity. Am Heart J. 1992 Mar;123(3):687–692. doi: 10.1016/0002-8703(92)90507-r. [DOI] [PubMed] [Google Scholar]
  3. Clark R. D., Lord S. R., Webster I. W. Clinical parameters associated with falls in an elderly population. Gerontology. 1993;39(2):117–123. doi: 10.1159/000213521. [DOI] [PubMed] [Google Scholar]
  4. Cummings S. R., Nevitt M. C., Kidd S. Forgetting falls. The limited accuracy of recall of falls in the elderly. J Am Geriatr Soc. 1988 Jul;36(7):613–616. doi: 10.1111/j.1532-5415.1988.tb06155.x. [DOI] [PubMed] [Google Scholar]
  5. Davies A. J., Kenny R. A. Falls presenting to the accident and emergency department: types of presentation and risk factor profile. Age Ageing. 1996 Sep;25(5):362–366. doi: 10.1093/ageing/25.5.362. [DOI] [PubMed] [Google Scholar]
  6. Dimant J. Accidents in the skilled nursing facility. N Y State J Med. 1985 May;85(5):202–205. [PubMed] [Google Scholar]
  7. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  8. Kapoor W. N. Diagnostic evaluation of syncope. Am J Med. 1991 Jan;90(1):91–106. doi: 10.1016/0002-9343(91)90511-u. [DOI] [PubMed] [Google Scholar]
  9. Kapoor W., Snustad D., Peterson J., Wieand H. S., Cha R., Karpf M. Syncope in the elderly. Am J Med. 1986 Mar;80(3):419–428. doi: 10.1016/0002-9343(86)90716-3. [DOI] [PubMed] [Google Scholar]
  10. Kenny R. A., Traynor G. Carotid sinus syndrome--clinical characteristics in elderly patients. Age Ageing. 1991 Nov;20(6):449–454. doi: 10.1093/ageing/20.6.449. [DOI] [PubMed] [Google Scholar]
  11. Lempert T., Bauer M., Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol. 1994 Aug;36(2):233–237. doi: 10.1002/ana.410360217. [DOI] [PubMed] [Google Scholar]
  12. Lipsitz L. A. Abnormalities in blood pressure homeostasis that contribute to falls in the elderly. Clin Geriatr Med. 1985 Aug;1(3):637–648. [PubMed] [Google Scholar]
  13. Lipsitz L. A. Syncope in the elderly. Ann Intern Med. 1983 Jul;99(1):92–105. doi: 10.7326/0003-4819-99-1-92. [DOI] [PubMed] [Google Scholar]
  14. Lipsitz L. A., Wei J. Y., Rowe J. W. Syncope in an elderly, institutionalised population: prevalence, incidence, and associated risk. Q J Med. 1985 Apr;55(216):45–54. [PubMed] [Google Scholar]
  15. McIntosh S. J., Lawson J., Kenny R. A. Clinical characteristics of vasodepressor, cardioinhibitory, and mixed carotid sinus syndrome in the elderly. Am J Med. 1993 Aug;95(2):203–208. doi: 10.1016/0002-9343(93)90261-m. [DOI] [PubMed] [Google Scholar]
  16. McIntosh S. J., Lawson J., Kenny R. A. Heart rate and blood pressure responses to carotid sinus massage in healthy elderly subjects. Age Ageing. 1994 Jan;23(1):57–61. doi: 10.1093/ageing/23.1.57. [DOI] [PubMed] [Google Scholar]
  17. McIntosh S., Da Costa D., Kenny R. A. Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic. Age Ageing. 1993 Jan;22(1):53–58. doi: 10.1093/ageing/22.1.53. [DOI] [PubMed] [Google Scholar]
  18. Morley C. A., Sutton R. Carotid sinus syncope. Int J Cardiol. 1984 Sep;6(3):287–293. doi: 10.1016/0167-5273(84)90188-8. [DOI] [PubMed] [Google Scholar]
  19. Petch M. C. Syncope. BMJ. 1994 May 14;308(6939):1251–1252. doi: 10.1136/bmj.308.6939.1251. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Rubenstein L. Z., Robbins A. S., Josephson K. R., Schulman B. L., Osterweil D. The value of assessing falls in an elderly population. A randomized clinical trial. Ann Intern Med. 1990 Aug 15;113(4):308–316. doi: 10.7326/0003-4819-113-4-308. [DOI] [PubMed] [Google Scholar]
  21. Sattin R. W. Falls among older persons: a public health perspective. Annu Rev Public Health. 1992;13:489–508. doi: 10.1146/annurev.pu.13.050192.002421. [DOI] [PubMed] [Google Scholar]
  22. Tinetti M. E., Speechley M., Ginter S. F. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988 Dec 29;319(26):1701–1707. doi: 10.1056/NEJM198812293192604. [DOI] [PubMed] [Google Scholar]
  23. Vellas B., Cayla F., Bocquet H., de Pemille F., Albarede J. L. Prospective study of restriction of activity in old people after falls. Age Ageing. 1987 May;16(3):189–193. doi: 10.1093/ageing/16.3.189. [DOI] [PubMed] [Google Scholar]
  24. Ward C., Kenny R. A. Reproducibility of orthostatic hypotension in symptomatic elderly. Am J Med. 1996 Apr;100(4):418–422. doi: 10.1016/S0002-9343(97)89517-4. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES