Syncope in the elderly: a clinical approach

In the elderly, syncope is a common and potentially hazardous event. The traditional diagnostic approach, which involves extensive procedural testing and hospitalization, will establish the diagnosis in only 40 to 50% of patients, but is associated with significant risk for iatrogenesis in older individuals. A focused approach based on clues from a detailed history and physical exam and knowledge of how age-related physiologic changes can affect presentation of illness in the elderly is emphasized. Treatment should focus on preventing recurrence, and the physician should take into consideration associated age and disease-related changes that may lead to iatrogenic complications. However, therapy should not be denied purely because of the patient's age.