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Syncope and Unexplained Falls in the Elderly

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Cardiac Management in the Frail Elderly Patient and the Oldest Old

Abstract

The prevalence of syncope increases with advancing age and is associated with significant morbidity and mortality. The diagnosis within this population can be complex due to atypical presentations, amnesia for events, absence of witnesses, and the overlap with other clinical presentations such as falls. Falls, which are not related to specific medical or accidental conditions, are defined as unexplained and may underlie a syncopal mechanism.

A comprehensive assessment of comorbid conditions and drug regimes coupled with standardized guidelines-based approaches to neurally mediated syncope, including active standing test, carotid sinus massage, and tilt testing, is recommended and these tests are generally well tolerated in older patients. Advances in cardiac monitoring devices have further enhanced the diagnostic yield for cardiac syncope. The treatment of syncope ranges from simple conservative measures to medications and permanent cardiac pacing.

Age per se should not be considered a barrier to assessment and treatment of syncope. On the contrary, given the much higher prevalence of cardiac causes of syncope, it could be argued that older patients with syncope and/or unexplained falls require an early and detailed investigation and management.

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Authors and Affiliations

  1. Careggi Hospital, Florence, Italy

    Martina Rafanelli

  2. Arrhythmology Centre, Department of Cardiology, Ospedali del Tigullio, 16033, Lavagna, Italy

    Michele Brignole

  3. School of Medicine, Trinity College Dublin, Health Sciences Institute, St James’s Hospital, Dublin 8, Ireland

    Rose Anne Kenny MD, PhD

Authors
  1. Martina Rafanelli
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  2. Michele Brignole
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  3. Rose Anne Kenny MD, PhD
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Correspondence to Rose Anne Kenny MD, PhD .

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Editors and Affiliations

  1. Hypertension Centre - Syncope Unit, Geriatrics Intensive Care Unit University of Florence and Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Andrea Ungar

  2. Professor of Internal Medicine-Geriatrics University of Florence Director, Cardiothoracovascular Department Azienda Ospedaliero-Universitaria Careggi, Florence, Italy

    Niccolò Marchionni

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Rafanelli, M., Brignole, M., Kenny, R.A. (2017). Syncope and Unexplained Falls in the Elderly. In: Ungar, A., Marchionni, N. (eds) Cardiac Management in the Frail Elderly Patient and the Oldest Old. Springer, Cham. https://doi.org/10.1007/978-3-319-43468-1_7

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