Complexity of syncope in elderly people: a comprehensive geriatric approach

Syncope is a prevalent health problem among elderly people. It may be neurally mediated or caused by conditions such as orthostatic hypotension, postprandial hypotension, and cardiac disorders. A combination of different aetiologies is not uncommon in the elderly people. Many pathophysiological processes, including age-related physiological changes, co-morbidities, concomitant medication use, and prolonged bedrest, coexist and predispose elderly people to syncope; advanced age and cardiac syncope are associated with increased mortality. Recurrent syncope and its co-morbidities, such as fall-related physical injury, negative psychological impact, and functional decline, may increase the dependency of elderly patients. Furthermore, the overlap between falls and syncope, and the interaction between syncope and frailty complicate management. Available clinical guidelines for the management of syncope that focus on diagnosis, investigation, and treatment are therefore insufficient to address syncope in elderly patients. A comprehensive geriatric approach that considers an individual's functional and cognitive capacities, as well as medical and psychosocial aspects, would be more appropriate.