Document Detail

The management of syncope in older adults.
MedLine Citation:
PMID:  19749680     Owner:  NLM     Status:  MEDLINE    
Syncope is a frequent symptom in older patients. The diagnostic and therapeutic management may be complex, particularly in older adults with syncope and comorbidities or cognitive impairment. Morbidity related to syncope is more common in older persons and ranges from loss of confidence, depressive illness and fear of falling, to fractures and consequent institutionalization. Moreover, advan-ced age is associated with short and long-term morbidity and mortality after syncope. A standardized approach may obtain a definite diagnosis in more than 90% of the older patients with syncope and may reduce diagnostic tools and hospitalizations. The initial evaluation, including anamnesis, medical examination, orthostatic hypotension test and electrocardiogram (ECG), may be more difficult in the elderly, specially for the limited value of medical history, particularly for the certain diagnosis of neuro-mediated syncope. For this reason neuroautonomic assessment is an essential step to confirm a suspect of neuromediated syncope. Orthostatic blood pressure measurement, head up tilt test, carotid sinus massage and insertable cardiac monitor are safe and useful investigations, particularly in older patients. The most common causes of syncope in the older adults are orthostatic hypotension, carotid sinus hypersensitivity, neuromediated syncope and cardiac arrhythmias. The diagnostic evaluation and the treatment of cardiac syncope are similar in older and young patients and for this reason will not be discussed. In older patients unexplained falls could be related to syncope, particularly in patients with retrograde amnesia. There are no consistent differences in the treatment of syncope between older and younger population, but a specific approach is necessary for orthostatic hypotension, drug therapy and pacemaker implantation.
A Ungar; A Morrione; M Rafanelli; E Ruffolo; M A Brunetti; V M Chisciotti; G Masotti; A Del Rosso; N Marchionni
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Minerva medica     Volume:  100     ISSN:  0026-4806     ISO Abbreviation:  Minerva Med.     Publication Date:  2009 Aug 
Date Detail:
Created Date:  2009-09-14     Completed Date:  2009-12-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0400732     Medline TA:  Minerva Med     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  247-58     Citation Subset:  IM    
Syncope Unit, Unit of Cardiology and Geriatric Medicine, Department of Critical Care Medicine and Surgery, University of Florence, Florence, Italy.
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MeSH Terms
Accidental Falls
Age Factors
Arrhythmias, Cardiac / complications
Carotid Sinus / physiopathology
Hypotension, Orthostatic / complications
Medical History Taking
Monitoring, Ambulatory / methods
Posture / physiology
Syncope* / etiology,  psychology,  therapy
Tilt-Table Test / methods

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