Syncope, falls in the elderly – what a family doctor should know

The frequency of syncope and falls increases with age, and their serious consequences leads us to look for their reasons and to implement prophylaxis. Although in the elderly, as in the younger group of people, the most frequent are neurally-mediated syncope, they are more often caused by orthostatic hypotension or carotid sinus hypersensitivity. Also the frequency of cardiac syncope is increasing, which is connected with higher mortality of affected subjects. The changes connected with the process of aging, comorbidity and pharmacotherapy as well as environmental conditions inconvenient for old people have resulted in increased frequency of falls in the elderly and increased morbidity and mortality. In the diagnostic process less credibility of the history, often scant or atypical symptoms, and the phenomena of amnesia of loss of consciousness should be taken into account. The diagnostics of both symptoms often requires the same examinations (ECG, orthostatic test, Holter monitoring, ambulatory blood pressure monitoring, carotid arteries ultrasound examination, carotid massage, tilt test, neurological evaluation) which is a result of similar causes and predisposing factors. In the case of falls in the history, gait and balance evaluation is also obligatory.