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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Updated: Oct 11, 2025

Evaluation of the Cognitive Performance of Hypertensive Patients with Silent Cerebrovascular Lesions
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Syncope and the aging patient: Navigating the challenges.

Tarek Hatoum1, Robert S Sheldon1

  • 1Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada.

Autonomic Neuroscience : Basic & Clinical
|December 2, 2021
PubMed
Summary
This summary is machine-generated.

Syncope in older adults is often non-cardiac, but comorbidities complicate diagnosis. Management focuses on medication review and targeted testing, with primary care playing a key role.

Keywords:
AgingDiagnosisElderlyPrognosisSyncopeTreatment

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Area of Science:

  • Geriatrics
  • Cardiology
  • Neurology

Background:

  • Syncope is common in the elderly, frequently caused by non-cardiac factors.
  • Co-morbidities, frailty, cognitive impairment, and polypharmacy complicate syncope presentation in older adults.
  • Vasovagal syncope and carotid sinus syndrome are common, but can be misdiagnosed as falls, leading to injury.

Purpose of the Study:

  • To review the diagnostic and management strategies for syncope in the elderly.
  • To highlight the challenges and specific considerations for syncope in older populations.
  • To emphasize the role of primary care and specialist referral in managing elderly syncope patients.

Main Methods:

  • Detailed history and physical examination, including medication review and orthostatic vital signs.
  • 12-lead electrocardiogram (ECG).
  • Head-up tilt testing, carotid sinus massage, and implantable loop recorders for diagnostic evaluation.

Main Results:

  • Non-cardiac causes are most common, but cardiovascular and neurodegenerative disorders are significant complicating factors.
  • Initial management involves medication review, particularly withdrawal of unnecessary vasoactive and psychotropic drugs.
  • Diagnostic tests like head-up tilt testing and carotid sinus massage are safe and accurate in the elderly.

Conclusions:

  • Conservative management and medication adjustment are key for non-cardiac syncope in the elderly.
  • Pharmacological and non-pharmacological therapies have limited efficacy and safety concerns.
  • A primary care-focused approach with targeted specialist referral is recommended for safe and effective management.