What's Different About Syncope in the Aged?

Syncope is a common and highly morbid syndrome with unique features in the elderly population. Syncope in the elderly is more likely due to the accumulation of multiple pathological conditions which threaten cerebral oxygen delivery, then to single diseases. Furthermore, age-related changes in blood pressure homeostasis make older patients more susceptible to hypotension during situational stresses such as posture change, eating a meal, or taking medications. An age-related impairment in baroreflex sensitivity may increase the risk of hypotension, but paradoxically protect older patients from the development of vasovagal syncope. Finally, the elderly are at greater risk of cardiovascular conditions such as myocardial infarction, valvular heart disease, and arrhythmias which often produce syncope. The evaluation of syncope in an elderly patient requires careful assessment of blood pressure during activities associated with a syncopal event, as well as attention to each of the contributing pathologic abnormalities that increase the risk of this syndrome.