The older patient with syncope: practicalities and controversies

The prevalence of syncope, in particular cardiac syncope, increases with advancing age and is associated with significant morbidity and mortality. Diagnosis of syncope within this population can be complex due to atypical presentations, amnesia for events and the overlap with falls. Thus, a lower threshold for investigation, preferably within a specialist syncope service, is necessary. Investigations for neurally mediated syncope, such as head-up tilt table testing, are well tolerated in the older patients, while advances in auto-activated cardiac monitoring devices have increased the diagnostic yield for cardiac syncope. The treatment of syncope ranges from simple conservative measures through to permanent cardiac pacing. This is a review of the existing literature highlighting the epidemiology, aetiology, clinical features, investigation and management strategies of syncope in the older population.