Highlights
- •Syncope and unexplained falls had a different prognosis according to their etiology.
- •Mortality rate was higher in TUF than benign syncope.
- •TUF was an independent predictor of one-year mortality in subjects with dementia.
- •Accurate assessment of syncope or fall in dementia is important for prognostication.
Abstract
Objective
To compare one-year mortality risk associated with syncope and unexplained fall in
older adults with dementia.
Methods
522 patients (aged >65 years) with dementia and history of transient loss of consciousness
and/or unexplained falls were evaluated. The diagnosis of syncope was based on European
Society of Cardiology guidelines. A “Syncopal Fall” was defined in patients with an
initial clinical presentation of unexplained fall, but a final diagnosis of syncope
after complete assessment. A “Truly Unexplained Fall” was defined in patients with
an initial clinical presentation of unexplained fall, in whom a diagnosis of syncope
had been excluded after the diagnostic work-up. One-year follow-up was assessed by
phone interview.
Results
Follow-up data were available for 501 participants (mean age 83 ± 6 years, 65% female).
After a mean follow-up of 324 ± 93 days, death from any cause was reported in 188
participants (24%). Advanced age, male sex, cognitive and functional impairment were
associated with a higher mortality rate. Patients with “Truly Unexplained Falls” had
a higher mortality risk compared with syncope and “Syncopal Fall”. A diagnosis of
“Truly Unexplained Falls” remained an independent predictor of one-year all-cause
mortality in multivariate model.
Conclusions
We propose the novel diagnostic category of “Truly Unexplained Fall”, resulting from
the application of syncope guidelines to subjects with unexplained falls. This condition
in older adults with dementia is a predictor of one-year all-cause mortality. For
this new high risk profile, we advice a comprehensive geriatric assessment focused
on risk factors for fall, aimed at a possible improvement of prognosis.
Keywords
Abbreviations:
ADL (Activities of Daily Living), CIRS (Cumulative Illness Rating Scale), CS (Confirmed Syncope), ESC (European Society of Cardiology), MMSE (Mini Mental State Examination), OH (Orthostatic Hypotension), SF (Syncopal Fall), SYD (Syncope and Dementia), TLOC (Transient Loss Of Consciousness), TUF (Truly Unexplained Fall)To read this article in full you will need to make a payment
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References
- The role of cognitive impairment in fall risk among older adults: a systematic review and meta-analysis.Age Ageing. 2012; 41: 299-308
- Hospitalization in community-dwelling persons with Alzheimer's disease: frequency and causes.J Am Geriatr Soc. 2010; 58: 1542-1548
- Etiology of syncope and unexplained falls in elderly patients with dementia. Syncope and dementia (SYD) study.J Am Geriatr Soc. 2016; 64: 1567-1573
- Differential diagnosis of unexplained falls in dementia: results of "syncope & dementia" registry.Eur J Intern Med. 2018; 50: 41-46
- Guidelines for the diagnosis and management of syncope (version 2009).Eur Heart J. 2009; 30: 2631-2671
- Study of illness in the aged. The index of ADL: a standardized measure of biological and psychosocial function.JAMA. 1963; 185: 914-919
- Assessment of older people: self-maintaining and instrumental activities of daily living.Gerontologist. 1969; 9: 179-186
- Mini mental state”: a practical method for grading the cognitive state of patients for the clinician.J Psychiatr Res. 1975; 12: 189-198
- Validation of the cumulative illness rating scale (CIRS) in hospitalized nonagenarians.Arch Gerontol Geriatr. 2007; 44: 29-36
- Interventions for preventing falls and fall-related fractures in community-dwelling older adults: a systematic review and network meta-analysis.J Am Geriatr Soc. 2021; 69: 2973-2984
- Incidence and prognosis of syncope.N Engl J Med. 2002; 347 (Sep 19): 878-885
- Two-year morbidity and mortality in elderly patients with syncope.Age Ageing. 2011; 40: 696-702
- Outcomes of unexplained syncope in the elderly.Am J Geriatr Cardiol. 2007; 16: 249-254
- Increasing prevalence of orthostatic hypotension as a cause of syncope with advancing age and multimorbidity.J Am Med Dir Assoc. 2019; 20: 586-588
Article info
Publication history
Published online: February 13, 2022
Accepted:
February 8,
2022
Received in revised form:
January 18,
2022
Received:
November 13,
2021
Identification
Copyright
© 2022 Published by Elsevier B.V. on behalf of European Federation of Internal Medicine.
