Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 53, Issue 6 M435-M440, Copyright © 1998 by The Gerontological Society of America
Prospective evaluation of unexplained syncope, dizziness, and falls among community-dwelling elderly adults
D O'Mahony and C Foote
Department of Medicine for the Elderly, Wycombe General Hospital, High Wycombe, Buckinghamshire, United Kingdom. [email protected]
BACKGROUND: Unexplained syncope, dizziness, and falls may present a
difficult diagnostic challenge to primary care and emergency room
physicians. The aim of this study was to evaluate a diagnostic algorithm in
the assessment of a cohort of community-dwelling elderly people with
symptoms of unexplained syncope, falls, or dizziness. METHODS: Fifty-four
consecutive elderly patients (mean age + SD = 76.4 + 8.0 years, range
61-91) were assessed over a 12-month period. Presenting symptoms were
syncope in 33 patients (61.1%), unexplained falls without loss of
consciousness in 10 patients (18.5%), and dizziness without loss of
consciousness in 11 (20.4%), and true vertigo in 2 patients (3.7%).
Patients were assessed systematically using the algorithm, followed up
until a diagnosis was made, and appropriate preventive therapy or advice
given. RESULTS: Diagnoses were obtained in 41 patients (75.9%). Of the 33
patients with syncope, the cause was identified in 23 (69.7%) as follows:
vasovagal in 12, arrhythmia in 5, hypotensive drugs in 3, orthostatic
hypotension in 2, and major anxiety with hyperventilation in 1. The cause
of syncope remained uncertain in 10 patients. Among the 10 patients with
nonsyncopal falls, the cause was identified in 9 as follows: drop attacks
with associated knee osteoarthritis or quadriceps muscle weakness in 3,
orthostatic hypotension in 2, and single cases of cerebellar ataxia,
Parkinson's disease, otologic vertigo, and vertebrobasilar insufficiency.
Of 11 patients with dizziness, 4 had vasovagal syncope, 2 had orthostatic
hypotension, 2 had otologic vertigo, one had carotid sinus syndrome, and
the cause remained obscure in 2. Nineteen of the 41 patients (46.3%) had at
least one other abnormality that was possibly contributory to their
symptoms. Five of the 13 patients without a clearcut diagnosis had
abnormalities of possible significance, including first-degree heart block
with fascicular block in 2 patients and individual patients with severe
hypertension, aortic valve disease, and vasodepressor carotid sinus
hypersensitivity. CONCLUSION: A targeted, problem-oriented algorithm
indicates the diagnosis in three quarters of elderly patients with
unexplained syncope, falls, and dizziness.
