Aging Clinical and Experimental Research

, Volume 26, Issue 1, pp 33–37 | Cite as

Clinical aspects and diagnostic relevance of neuroautonomic evaluation in patients with unexplained falls

  • M. Rafanelli
  • E. Ruffolo
  • V. M. Chisciotti
  • M. A. Brunetti
  • A. Ceccofiglio
  • F. Tesi
  • A. Morrione
  • N. Marchionni
  • A. Ungar
Original Article



To evaluate the diagnostic relevance of neuroautonomic evaluation in patients with unexplained falls compared to those with a syncope etiologically unexplained after initial evaluation.


It is an observational study, comparing 298 patients with unexplained fall with 989 patients with unexplained syncope. Each patient underwent supine and upright blood pressure measurement, tilt testing (TT) and carotid sinus massage (CSM).


Patients with unexplained falls were older (75.3 ± 11.1 vs. 63.2 ± 19.2 years, p < 0.001), were more frequently hypertensive (66.1 vs. 47.2 %, p < 0.001) and more frequently prescribed antihypertensive drugs (62.4 vs. 48.7 %, p < 0.001) or benzodiazepines (15.7 vs. 10.6 %, p = 0.01), and in a greater proportion they experienced major traumatic injuries (77.5 vs. 29.6 %, p < 0.001) as a consequence of falls. The TT was less frequently positive in patients with unexplained falls (36 vs. 51.3 %, p < 0.001), whereas a Carotid Sinus Syndrome as suggested by CSM had a similar prevalence in the two groups (14.3 vs. 10.5 %, p = 0.074). Overall, either TT or CSM were positive in 61 % of patients with unexplained falls, and in 64 % of those with syncope (p = 0.346). After matching by age 298 patients with falls (75.3 ± 11.1 years) and 298 patients with unexplained syncope (75.4 ± 11.1 years), we found that the positivity prevalence of TT and CSM were similar in the two groups.


The positivity prevalence of TT and CSM in patients with unexplained falls compared to patients with unexplained syncope is similar. Given its high diagnostic relevance, the neuroautonomic evaluation should be routinely performed in older patients with unexplained falls.


Unexplained falls Syncope Neuroautonomic evaluation 



This is an analysis of data collected by the Syncope Unit of the Division of Geriatric Cardiology and Medicine, Azienda Ospedaliero-Universitaria Careggi, Florence. The analyses described here are only the responsibility of the authors and make no mention of trade names, commercial products or organizations.

Conflict of interest

There are no financial or other relationships with industry that might lead to conflict of interest.


  1. 1.
    Kenny RA, O’Shea D (2002) Falls and syncope in elderly patients. Clin Geriatr Med 18:XIII–XIVPubMedCrossRefGoogle Scholar
  2. 2.
    Malasana G, Brignole M, Daccarett M, Sherwood R, Hamdan MH (2011) The prevalence and cost of the faint and fall problem in the State of Utah. Pacing Clin Electrophysiol 34:278–283PubMedCrossRefGoogle Scholar
  3. 3.
    Scuffham P, Chaplin S, Legood R (2003) Incidence and costs of unintentional falls in older people in the United Kingdom. J Epidemiol Community Health 57:740–744PubMedCrossRefGoogle Scholar
  4. 4.
    Sachpekidis V, Vogiatzis I, Dadous G, Kanonidis I, Papadopulos C, Sakadamis G (2009) Carotid sinus hypersensitivity is common in patients presenting with hip fracture and unexplained falls. Pacing Clin Electrophysiol 32:1184–1190PubMedCrossRefGoogle Scholar
  5. 5.
    Parry SW, Steen IN, Baptist M, Kenny RA (2005) Amnesia for loss of consciousness in carotid sinus syndrome: implications for presentations with falls. J Am Coll Cardiol 45:1840–1843PubMedCrossRefGoogle Scholar
  6. 6.
    Moya A, Sutton R, Ammirati F, Blanc JJ, Brignole M, Dahm JB et al (2009) Task force for the diagnosis and management of syncope. Eur Heart J 30:2631–2671PubMedCrossRefGoogle Scholar
  7. 7.
    Masud T, Morris RO (2001) Epidemiology of falls. Age Ageing 30:3–7PubMedCrossRefGoogle Scholar
  8. 8.
    Bartoletti A, Alboni P, Ammirati F et al (2000) “The Italian Protocol”: a simplified head-up tilt testing potentiated with oral nitroglycerin to assess patients with unexplained syncope. Europace 2:339–342PubMedCrossRefGoogle Scholar
  9. 9.
    Puggioni E, Guiducci V, Brignole M et al (2002) Results and complications of the carotid sinus massage performed according to the “method of symptoms”. Am J Cardiol 89:599–601PubMedCrossRefGoogle Scholar
  10. 10.
    Brignole M, Menozzi C, Del Rosso A, Costa S, Gaggioli G, Bottoni N et al (2000) New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the pre-syncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope International Study. Europace 2:66–76PubMedCrossRefGoogle Scholar
  11. 11.
    Anpalahan M, Gibson S (2012) The prevalence of neurally mediated syncope in older patients presenting with unexplained falls. Eur J Int Med 23:48–52CrossRefGoogle Scholar
  12. 12.
    Paling D, Vilches-Moraga A, Akram Q, Atkinson O, Staniland J, Paredes-Galan E (2011) Carotid sinus syndrome is common in very elderly patients undergoing tilt table testing and carotid sinus massage because of syncope or unexplained falls. Aging Clin Exp Res 23:304–308PubMedCrossRefGoogle Scholar
  13. 13.
    Hartikainen S, Lonnroon E, Louhivuori K (2007) Medication as a risk factor for falls: critical systematic review. J Gerontol 62A:1172–1181CrossRefGoogle Scholar
  14. 14.
    Becker C, Loy S, Nikolaus T, Rissmann U, Rapp K, Lindemann B et al (2006) A follow-up study on fall and fracture incidence in long-term care including the role of formal caregiver time on fall incidence rates. Z Gerontol Geriatr 39:292–296PubMedCrossRefGoogle Scholar
  15. 15.
    Ungar A, Mussi C, Del Rosso A, Noro G, Abete P, Ghirelli L et al (2006) Diagnosis and characteristics of syncope in older patients referred to geriatric departments. J Am Geriatr Soc 54:1531–1536PubMedCrossRefGoogle Scholar
  16. 16.
    Carey BJ, Potter JF (2001) Cardiovascular causes of falls. Age Ageing 30(Suppl 4):19–24PubMedCrossRefGoogle Scholar
  17. 17.
    Kenny RA, Traynor G (1991) Carotid sinus syndrome: clinical characteristics in elderly patients. Age Aging 20:449–454CrossRefGoogle Scholar
  18. 18.
    Kenny RA, Richardson DA, Steen N, Bexton RS, Shaw FE, Bond J (2001) Carotid sinus syndrome: a modifiable risk factor for nonaccidental falls in older adults (SAFE PACE). J Am Coll Cardiol 38:1491–1496PubMedCrossRefGoogle Scholar
  19. 19.
    Brignole M, Ungar A, Bartoletti A, Ponassi I, Lagi A, Mussi C et al (2006) Standardized-care pathway versus usual management of syncope patients presenting as emergencies at general hospitals. Europace 8:644–650PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2013

Authors and Affiliations

  • M. Rafanelli
    • 1
  • E. Ruffolo
    • 1
  • V. M. Chisciotti
    • 1
  • M. A. Brunetti
    • 1
  • A. Ceccofiglio
    • 1
  • F. Tesi
    • 1
  • A. Morrione
    • 1
  • N. Marchionni
    • 1
  • A. Ungar
    • 1
  1. 1.Syncope Unit, Division of Geriatric Cardiology and MedicineUniversity of Florence and Azienda Ospedaliero-Universitaria CareggiFlorenceItaly

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