Monitoring devices for falls and syncope

Monitoring devices are an important adjunct to the clinical assessment of patients who experience falls. The use of these devices should be guided by the clinical history, a physical assessment, and routine investigations. Quantitative measures of postural sway should be used in conjunction with clinical measures to provide a more accurate assessment of gait and balance. Assessment of blood pressure changes during the investigation of neurocardiovascular causes of syncope and falls in older adults should be performed with noninvasive digital photoplethysmographic devices, so long as their appropriate use and limitations are applied and understood. Only minimal information can be gained from short-term heart rate and rhythm monitoring in patients with infrequent symptoms. The usefulness of long-term ECG monitoring (with both external and implantable recorders) is well established for the diagnosis of unexplained syncope but requires further assessment in older individuals who experience falls. Twenty-four-hour measurements of ambulatory blood pressure generally are not diagnostically helpful in patients who experience falls or syncope but do have a role in the monitoring of therapeutic interventions.