ABSTRACT
Syncope is a quite common clinical condition in the older population. The diagnostic and therapeutic management may be complex, particularly in older adults with syncope and co-morbidities or cognitive impairment. A standardized approach may obtain a definite diagnosis in more than 90% of the older patients and reduce health care costs for unnecessary diagnostic tests and hospitalizations. The initial evaluation, including clinical history, physical examination, active standing test and 12-leads electrocardiogram, may be more difficult in the elderly, especially for the limited value of clinical history, particularly for the certain diagnosis of neuro-mediated syncope. Orthostatic blood pressure measurement, tilt testing, carotid sinus massage and insertable cardiac monitor are safe and useful investigations, particularly in older patients. There are no consistent differences in the treatment of syncope between older and younger population, but a specific approach is necessary for orthostatic hypotension, drug therapy and pacemaker implantation.
The prevalence of syncope increases with advancing age. The diagnosis of syncope in the older population may be complex due to atypical presentations, amnesia for the loss of consciousness, absence of witnesses and the overlap with other clinical presentations such as falls. Age per se should not limit the assessment and treatment of syncope. A comprehensive assessment of comorbidities and drugs regimen is mandatory. A standardized guidelines-based approach based on blood pressure measurement in supine and upright position, carotid sinus massage and tilt testing is well tolerated in older patients. Prolonged electrocardiogram monitoring has increased the diagnostic yield for cardiac syncope. The treatment of syncope ranges from non-pharmacological measures to permanent cardiac pacing.
