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Syncope in the Elderly

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Acute

What is Syncope in the Elderly ?

Syncope is a sudden, temporary loss of consciousness due to reduced blood flow to the brain, often followed by spontaneous recovery. In older adults, it is a common and potentially serious condition that may signal underlying cardiovascular, neurological, or metabolic problems.

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Symptoms

  • Sudden fainting or collapse
  • Light-headedness or dizziness before the episode
  • Blurred vision, nausea, or sweating
  • Temporary confusion after regaining consciousness
  • Pale or clammy skin

Complications

  • Falls and injuries due to sudden loss of consciousness
  • Fractures, especially hip fractures in frail older adults
  • Fear of recurrence, leading to reduced activity or social isolation
  • Delayed diagnosis of serious underlying conditions (e.g., arrhythmias)

Causes

  • Cardiovascular Arrhythmias, aortic stenosis, orthostatic hypotension, heart block
  • Reflex (vasovagal) Triggered by emotional stress, pain, or prolonged standing
  • Orthostatic hypotension Sudden drop in blood pressure when standing
  • Medication-related Antihypertensives, diuretics, or sedatives
  • Dehydration or malnutrition

Prevention

  • Adequate hydration and salt intake (as advised)
  • Review and adjust medications that may contribute to low blood pressure
  • Slow position changes (e.g., sitting up before standing)
  • Regular physical activity to improve circulation and muscle tone
  • Avoiding known triggers (e.g., standing for too long, hot environments)

Risk factor

  • Advanced age
  • History of cardiovascular disease
  • Polypharmacy (multiple medications)
  • Dehydration or recent illness
  • Cognitive impairment
  • Frailty or reduced mobility

Treatment

  • Identify and treat the underlying cause (e.g., cardiac arrhythmia, medication side effect)
  • Monitoring vital signs and performing ECG, blood tests, and orthostatic BP measurements
  • Medication review Adjust or discontinue contributing drugs
  • Cardiology or neurology referral as indicated
  • Lifestyle modifications Compression stockings, fluid/salt management
  • Geriatrician involvement
    • For comprehensive assessment, fall risk evaluation, and personalized management and to Identify and treat the underlying cause
    • Coordination with other specialists and ensuring safe aging in place

How is it diagnosed?

How is it diagnosed?
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