Multifactorial Syncope in Older People

It is common for there to be multiple contributory factors involved in a syncopal episode in older people as illustrated in the example below.

Jack, aged 85 years old, collapsed when he stood up after going out for lunch with his son. His assessment revealed the following factors contributed to his collapse

• relative dehydration – as he had eaten and drunk very little that morning ‘to make the most of the lunch’
• warm restaurant causing peripheral vasodilation
• alcohol causing diuresis and peripheral vasodilation
• prolonged sitting still, causing peripheral pooling of blood in legs (loss of muscle compression of buttock and leg veins to increase venous return).
• large meal resulting in postprandial hypotension
• age-related changes causing a slower compensation to standing up
• background unsteadiness causing loss of balance and fall with hypotension

 

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