Syncope can have devastating consequences, resulting in injuries, accidents or even death. Causes of syncope in older adults include orthostatic hypotension, carotid sinus syndrome, vasovagal syncope and many more. In the recently published World Falls Guidelines, syncope in older adults often presents as falls, especially in those prone to falls. In residents with unexplained falls, special attention to syncope is recommended. If misdiagnosed, i.e., mistaken for TIAs, epileptic seizures, etc. many weeks/months are spent being referred to multiple specialists for unnecessary diagnostic testing.  

Let’s get back to basics, orthostatic hypotension and falls are not new to those of us caring for seniors. It is no surprise that orthostatic hypotension is considered the most common cause of syncope and is an important risk factor for falls. Then consider how many of your residents have orders for anti-hypertensive medications, probably many. These medications can also worsen orthostatic hypotension. Is it the chicken or the egg?  

Assessing falls is a key geriatrician medical competence and identifying and diagnosing syncope is an important part of this. Age and Ageing have compiled a collection of 15 key syncope themed papers. A commentary to accompany this collection was written by the authors and can be found at the link below. This might be a good time to discuss falls at your QAPI committee and consider syncope as a contributing factor. How many residents receiving blood pressure medications have experienced a fall? Is there a pattern to their falls, i.e., several hours post medication? We all track, and trend falls but if you haven’t considered syncope as being the cause you may have an aha moment! Take a look! Stay well and stay informed! 

For more information:  

HealthCap RMS: Root Cause Analysis (healthcapusa.com) 

hcrmi_06a1f476431cad076681e538346e68ec.pdf (rackcdn.com) 

6336c576d7f0d75432325b01_Falls prevention by design whitepaper.pdf (webflow.com) 

hcrmi_d8603c329ce29fe5a54751ec00b740f1.pdf (rackcdn.com)