The prevalence of Neurally Mediated Syncope in older patients presenting with unexplained falls
Abstract
Aims To determine the prevalence and clinical significance of carotid sinus syndrome (CSS) and vasovagal syncope (VVS), the two common types of Neurally Mediated Syncope (NMS), in a cohort of older patients with unexplained falls. Methods Patients presenting with unexplained and accidental falls were identified from 200 consecutive admissions of falls in patients aged 65 years and older admitted to the Rapid Assessment Medical Unit (RAMU) in a teaching hospital. A sample of unexplained and accidental fallers underwent carotid sinus massage (CSM) and tilt table testing (TTT) as per a standardised protocol. Baseline characteristics, clinical variables and the prevalence of NMS were compared between the two groups. Results Falls were unexplained in 26% of patients. The prevalence of NMS was 24% (5/21) among patients with unexplained falls who underwent assessment for NMS, whereas it was nil (0/17) in patients with accidental falls (P=0.050). The prevalence of previous falls was significantly higher in patients with unexplained falls (P=0.0025), but all other baseline characteristics were similar between the two groups. Conclusion Falls are unexplained in a significant number of older patients presenting to acute hospitals. The assessment of unexplained fallers for NMS is clinically important as this may be aetiologically related in nearly a quarter of these patients.
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The incidence of syncope in older adults is high.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [666]
The diagnosis of syncope in older adults is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [666]
The differential diagnosis of syncope in older adults is broad.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [666]
Secondary morbidity from syncope in older adults is high because of comorbidities, physical injury, and frailty.
“The management of syncope in older adults is particularly challenging: The incidence is high; the differential diagnosis is broad; the diagnosis is imprecise because of amnesia, falls, lack of witnesses, and polypharmacy; and secondary morbidity is high because of comorbidities, physical injury, and frailty (35,45,666–675).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [666]
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- Authors
- Anpalahan, M., & Gibson, S.
- Affiliations
- Western Health (AU)
- National Ageing Research Institute (AU)
- Corresponding author
- Anpalahan, Mahesan
- Venue
- European Journal of Internal Medicine
- Publisher
- Elsevier BV
- Published
- 2012-03
- Volume
- 23
- Issue
- 2
- Pages
- e48-e52
- ISSN
- 0953-6205 (ISSN-L)
- OpenAlex
- W2088791619
- Cited by
- 19
- References
- 30
- Citations by year
- 2023: 1 · 2021: 1 · 2020: 1 · 2018: 1 · 2017: 8 · 2016: 1 · 2013: 4 · 2012: 1
- FWCI
- 1.64
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Internal Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Surgery › Cardiovascular Syncope and Autonomic Disorders
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Balance, Gait, and Falls Prevention
- Life Sciences › Neuroscience › Neurology › Vestibular and auditory disorders
- Keywords
- neurally mediated syncope, carotid sinus syndrome, vasovagal syncope, unexplained falls, falls, elderly patients, prevalence, carotid sinus massage, tilt table test, fall history
- MeSH terms
- Accidental Falls, Aged, Diagnostic Imaging, Electrocardiography, Female, Humans, Male, Risk Factors, Victoria, Prevalence, Risk Assessment, Tilt-Table Test, Syncope, Vasovagal
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