Syncope and Unexplained Falls in the Elderly

  • Martina Rafanelli
  • Michele Brignole
  • Rose Anne KennyEmail author


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.


Orthostatic Hypotension Multiple System Atrophy Retrograde Amnesia Cerebral Hypoperfusion Tilt Test 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  • Martina Rafanelli
    • 1
  • Michele Brignole
    • 2
  • Rose Anne Kenny
    • 3
    Email author
  1. 1.Careggi HospitalFlorenceItaly
  2. 2.Arrhythmology Centre, Department of CardiologyOspedali del TigullioLavagnaItaly
  3. 3.School of MedicineTrinity College Dublin, Health Sciences Institute, St James’s HospitalDublin 8Ireland

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