Syncope toolkit

Syncope is very common and will affect 42% of people during their lifetime

Falls and syncope

  • Syncope and falls increase with age. Contributing factors include changes in body physiology, dehydration and increased mediation use
  • 25% of older people will fall each year, and a fifth of these falls will cause serious injury such as a fractured hip or traumatic brain injury
  • There is strong consensus that the management of unexplained falls should be the same as that for unexplained syncope
  • Non-accidental falls (NAF) may represent under reporting of syncope, or present as syncope in older age groups.

Amnesia associated loss of consciousness (A-LoC)

  • A-LoC associated with syncope is a key factor in unexplained falls, especially in older adults. In one study, forty-two per cent of patients over 60 years of age experienced A-LoC post-tilt table induced syncope - they had no recollection of having fainted
  • To compound this problem, witness accounts are only be available in just over half of older people experiencing syncope
  • Impaired cognitive function and blood pressure changes do not seem to be risk factors for A-LoC.

Carotid Sinus Syndrome (CSS) and A-LoC

  • It is reported that 30% of patients with carotid sinus syndrome have A-LoC
  • In patients with unexplained falls 95% had A-LoC during CSS and 27% who presented with syncope had A-LoC
  • This again illustrates the difficulty in assessing patients who may lack warning symptoms and witness accounts for the event.

Vasovagal syncope (VVS) and A-LoC

  • Although the first peak of incidence of VVS occurs in teenagers, up to 40% of unexplained recurrent syncope in older individuals is due to VVS, constituting the second peak.(134) The lower reported prevalence of VVS in the older population may be attributable to a lack of prodromal symptoms, unavailable witness accounts, or the presence of cognitive deficits
  • One trial suggests a prevalence of A-LoC with vasovagal syncope of 28%, with increasing age associated with a higher prevalence of A-LOC but a significant proportion (20%) of younger patients are also affected by A-LOC
  • Patients with A-LOC and VVS are more likely to have had a fracture associated with a syncopal episode or unexplained fall in the past
  • NICE guidance Falls Assessment and prevention of falls in older people.

Read Falls and syncope case histories

Falls and syncope case histories