The overlap between syncope and falls in the elderly
Open accessAbstract
Summary: 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.
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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 [670]
The Abstract describes amnesia, falls presenting without reported syncope, and the frequent absence of witnesses as obstacles to identifying syncope in older adults. The Lack of Witness Account section likewise says witnesses can supply history needed for diagnosis. The paper lists drug-induced syncope as a possible cause, but does not identify polypharmacy as a reason diagnosis is imprecise; no page numbers are available in our copy. (LLM, conf=0.88)
Experimental — accuracy not yet measuredSecondary 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 [670]
The Healthcare implications section (page unavailable) states that morbidity is increased in older people who fall or have syncope, and reports injuries and fractures among older patients with carotid sinus syndrome. It does not identify comorbidities or frailty as causes of that morbidity; its mention of frail day-hospital attendees is a comparison group. (LLM, conf=0.87)
Experimental — accuracy not yet measuredPhysical injuries associated with falls, collisions, or trauma more commonly result from syncope in old age.
“Although some of the risk is attributable to the aspects of syncope described in this guideline, among older adults such risks are usually compounded by multiple morbidities and frailty, which add to age-related vulnerability to syncope (671,681,682), and by the physical injuries associated with falls, collisions, or trauma, which more commonly result from syncope in old age (670).”
From 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope (2017) · cites this paper as [670]
The Healthcare implications section reports injuries among elderly patients with carotid sinus syndrome and discusses morbidity from falls associated with syncope. It does not establish that syncope-related injuries are more common in older than younger people, or address collisions or other trauma specifically. No page number is available in our copy. (LLM, conf=0.84)
Experimental — accuracy not yet measuredThe 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 [670]
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 [670]
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Cites
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- Authors
- Shaw, F. E., & Kenny, R. A.
- Affiliations
- Royal Victoria Infirmary (GB)
- ORCID
- Venue
- Postgraduate Medical Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 1997-10-01
- Volume
- 73
- Issue
- 864
- Pages
- 635-639
- ISSN
- 0032-5473 (ISSN-L)
- 1469-0756
- PMC
- PMC2431481
- OpenAlex
- W2102833071
- Cited by
- 137
- References
- 1
- Citations by year
- 2026: 1 · 2025: 1 · 2023: 5 · 2022: 7 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 6 · 2017: 9 · 2016: 5 · 2015: 4 · 2014: 7 · 2013: 7 · 2012: 4
- FWCI
- 0.40
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Postgraduate Medical Journal (publishedVersion)
- PubMed Central (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
- syncope, falls in older adults, carotid sinus syndrome, postprandial hypotension, orthostatic hypotension, dizziness, missed diagnosis, cardiovascular syncope
- MeSH terms
- Accidental Falls, Aged, Amnesia, Carotid Artery Diseases, Carotid Sinus, Diagnosis, Differential, Humans, Syncope, Syndrome
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