{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:38:28Z","timestamp":1787017108920,"version":"build-2736575974"},"reference-count":32,"publisher":"Oxford University Press (OUP)","issue":"864","license":[{"start":{"date-parts":[[1997,10,1]],"date-time":"1997-10-01T00:00:00Z","timestamp":875664000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1997,10,1]]},"abstract":"<jats:title>Summary<\/jats:title>\n                  <jats:p>Syncope and falls are often considered to be two separate diagnoses with two separate sets of aetiologies. However, although it remains controversial, the existence of an overlap between syncope and falls is becoming increasingly acknowledged. In the elderly, determining the cause of a fall can be difficult. Approximately 30% of cognitively normal elderly people are unable to recall documented falls three months later and a witness account for syncopal events is unavailable in about 50% of patients. We have found that in almost 40% of patients in whom an attributable diagnosis of carotid sinus syndrome was made, the only presenting symptoms were falls alone or falls with dizziness; syncope was denied. Amnesia for loss of consciousness can be demonstrated in over 20% of all patients with a diagnosis of carotid sinus syndrome and in 50% of those patients who present only with falls or falls and dizziness. There is a suggestion from studies in postprandial hypotension and orthostatic hypotension, where similar haemodynamic changes are found in patients complaining of either syncope or falls, that this phenomenon may be generalisable. The importance of the presence of an overlap between syndrome and falls in the elderly lies in the healthcare implications of missed diagnoses of cardiovascular syncope for which there are established effective treatments. Consideration of syncope in the differential diagnosis of unexplained falls should reduce the numbers of falls for which no attributable diagnosis is found and result in an improved standard of health care for elderly patients who fall.<\/jats:p>","DOI":"10.1136\/pgmj.73.864.635","type":"journal-article","created":{"date-parts":[[2008,12,29]],"date-time":"2008-12-29T16:49:00Z","timestamp":1230569340000},"page":"635-639","source":"Crossref","is-referenced-by-count":106,"title":["The overlap between syncope and falls in the elderly"],"prefix":"10.1093","volume":"73","author":[{"given":"F E","family":"Shaw","sequence":"first","affiliation":[{"name":"Cardiovascular Investigation Unit and Institute for the Health of the Elderly, Department of Medicine (Geriatric Medicine), Royal Victoria Infirmary , Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R A","family":"Kenny","sequence":"additional","affiliation":[{"name":"Cardiovascular Investigation Unit and Institute for the Health of the Elderly, Department of Medicine (Geriatric Medicine), Royal Victoria Infirmary , Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[1997,10,1]]},"reference":[{"key":"ref_1","article-title":"Morbidity is also increased in the elderly who fall16 or have syncope27 but again the potential additional morbidity that accompanies falls caused by undiagnosed and therefore untreated syncope is difficult to quantify. However, for carotid sinus syndrome, data from our 'syncope' clinic found that 49% of elderly patients sustained an injury prior to diagnosis and of injured patients, 52% sustained a fracture.4 We have also demonstrated an association between carotid sinus hypersensitivity and fracture neck of femur.5'28 Carotid sinus hypersensitivity was present in 36% of patients with fracture neck of femur compared to none of the patients admitted for elective surgery, 17% of patients admitted acutely for reasons other than falls, and 13% of frail day-hospital attenders. In addition to physical injuries, unexplained or recurrent falls can produce a fear of falling in the elderly, with the subsequent loss of confidence resulting in restriction of activities and ultimately loss of independence.12'29","unstructured":"Morbidity is also increased in the elderly who fall16 or have syncope27 but again the potential additional morbidity that accompanies falls caused by undiagnosed and therefore untreated syncope is difficult to quantify. However, for carotid sinus syndrome, data from our 'syncope' clinic found that 49% of elderly patients sustained an injury prior to diagnosis and of injured patients, 52% sustained a fracture.4 We have also demonstrated an association between carotid sinus hypersensitivity and fracture neck of femur.5'28 Carotid sinus hypersensitivity was present in 36% of patients with fracture neck of femur compared to none of the patients admitted for elective surgery, 17% of patients admitted acutely for reasons other than falls, and 13% of frail day-hospital attenders. In addition to physical injuries, unexplained or recurrent falls can produce a fear of falling in the elderly, with the subsequent loss of confidence resulting in restriction of activities and ultimately loss of independence.12'29"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1136\/bmj.308.6939.1251","article-title":"Syncope: an accurate history tells all","volume":"308","author":"Petch, M.C.","year":"1994","unstructured":"Petch MC. Syncope: an accurate history tells all. BMJ 1994; 308: 1251-2.","journal-title":"BMJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"449","DOI":"10.1093\/ageing\/20.6.449","article-title":"Carotid sinus syndrome - clinical characteristics in elderly patients","volume":"20","author":"Kenny, R.A.; Traynor, G.","year":"1991","unstructured":"Kenny RA, Traynor G. Carotid sinus syndrome - clinical characteristics in elderly patients. Age Ageing 1991; 20: 449-54.","journal-title":"Age Ageing"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1093\/ageing\/22.1.53","article-title":"Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic","volume":"22","author":"McIntosh, S.; Da Costa, D.; Kenny, R.A.","year":"1993","unstructured":"McIntosh S, Da Costa D, Kenny RA. Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic. Age Ageing 1993; 22: 53-8.","journal-title":"Age Ageing"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"203","DOI":"10.1016\/0002-9343(93)90261-M","article-title":"Clinical characteristics of vasodepressor, cardioinhibitory and mixed carotid sinus syndrome in the elderly","volume":"95","author":"McIntosh, S.J.; Lawson, J.; Kenny, R.A.","year":"1993","unstructured":"McIntosh SJ, Lawson J, Kenny RA. Clinical characteristics of vasodepressor, cardioinhibitory and mixed carotid sinus syndrome in the elderly. Am Jt Med 1993; 95: 203 - 8.","journal-title":"Am Jt Med"},{"key":"ref_6","first-page":"107","article-title":"Carotid sinus syndrome","volume-title":"Syncope in the older patient","author":"Kenny, R.A.; McIntosh, S.J.","year":"1996","unstructured":"Kenny RA, McIntosh SJ. Carotid sinus syndrome. In: Kenny RA, ed. Syncope in the older patient. London: Chapman and Hall, 1996; pp 107-22."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"418","DOI":"10.1016\/S0002-9343(97)89517-4","article-title":"Reproducibility of orthostatic hypotension in symptomatic elderly","volume":"100","author":"Ward, C.; Kenny, R.A.","year":"1996","unstructured":"Ward C, Kenny RA. Reproducibility of orthostatic hypotension in symptomatic elderly. Am J Med 1996; 100: 418-22.","journal-title":"Am J Med"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1093\/ageing\/25.5.362","article-title":"Falls presenting to the accident and emergency department: types of presentation and risk factor profile","volume":"25","author":"Davies, A.J.; Kenny, R.A.","year":"1996","unstructured":"Davies AJ, Kenny RA. Falls presenting to the accident and emergency department: types of presentation and risk factor profile. Age Ageing 1996; 25: 362-6.","journal-title":"Age Ageing"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"308","DOI":"10.7326\/0003-4819-113-4-308","article-title":"The value of assessing falls in an elderly population","volume":"113","author":"Rubenstein, L.Z.; Robbins, A.S.; Josephson, K.R.; Schulman, B.L.; Osterweil, D.","year":"1990","unstructured":"Rubenstein LZ, Robbins AS, Josephson KR, Schulman BL, Osterweil D. The value of assessing falls in an elderly population. 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Clin Geriatr Med 1985; 1: 637 - 48.","journal-title":"Clin Geriatr Med"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"92","DOI":"10.7326\/0003-4819-99-1-92","article-title":"Syncope in the elderly","volume":"99","author":"Lipsitz, L.A.","year":"1983","unstructured":"Lipsitz LA. Syncope in the elderly. Ann Intern Med 1983; 99: 92-105.","journal-title":"Ann Intern Med"},{"key":"ref_13","first-page":"1","article-title":"Introduction","volume-title":"Syncope in the older patient","author":"Kenny, R.A.","year":"1996","unstructured":"Kenny RA. Introduction. In: Kenny RA, ed. Syncope in the older patient. London: Chapman and Hall, 1996; pp 1-14."},{"key":"ref_14","first-page":"91","article-title":"Diagnostic evaluation of syncope","volume":"90","author":"Kapoor, W.N.","year":"1991","unstructured":"Kapoor WN. Diagnostic evaluation of syncope. 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Dan Med Bull 1987; 34(suppl 4): 1-24.","journal-title":"Dan Med Bull"},{"issue":"1701","key":"ref_17","first-page":"7","article-title":"Risk factors for falls among elderly persons living in the community","volume":"319","author":"Tinetti, M.E.; Speechley, M.; Ginter, S.F.","year":"1988","unstructured":"Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. NEnglJ'Med 1988; 319: 1701 7.","journal-title":"NEnglJ'Med"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1159\/000213521","article-title":"Clinical parameters associated with falls in an elderly population","volume":"39","author":"Clark, R.D.; Lord, SR, Webster; I.W.","year":"1993","unstructured":"Clark RD, Lord SR, Webster IW. Clinical parameters associated with falls in an elderly population. Gerontology 1993; 39: 117 - 23.","journal-title":"Gerontology"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"613","DOI":"10.1111\/j.1532-5415.1988.tb06155.x","article-title":"Forgetting falls: the limited accuracy of recall of falls in the elderly","volume":"36","author":"Cummings, SR, Nevitt; MC, Kidd; S.","year":"1988","unstructured":"Cummings SR, Nevitt MC, Kidd S. Forgetting falls: the limited accuracy of recall of falls in the elderly. J Am Geiatr Soc 1988; 36: 613 - 6.","journal-title":"J Am Geiatr Soc"},{"key":"ref_20","first-page":"189","article-title":"\"Minimental state\": a practical method for grading the cognitive state of patients for the clinician","volume":"12","year":"1975","unstructured":"Folstein MF, Folstein SE, McHugh PR. \"Minimental state\": a practical method for grading the cognitive state of patients for the clinician. J Psychiarr Res 1975; 12: 189 - 98. Syncope andfalls in the elderly","journal-title":"J Psychiarr Res"},{"key":"ref_21","first-page":"202","article-title":"Accidents in the skilled nursing facility","volume":"85","author":"Dimant, J.","year":"1985","unstructured":"Dimant J. Accidents in the skilled nursing facility. NY State J Med 1985; 85: 202-5.","journal-title":"NY State J Med"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1093\/ageing\/23.1.57","article-title":"Heart rate and blood pressure responses to carotid sinus massage in healthy elderly subjects","volume":"23","author":"McIntosh, S.J.; Lawson, J.; Kenny, R.A.","year":"1994","unstructured":"McIntosh SJ, Lawson J, Kenny RA. Heart rate and blood pressure responses to carotid sinus massage in healthy elderly subjects. Age Ageing 1994; 23: 57-61.","journal-title":"Age Ageing"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/0167-5273(84)90188-8","article-title":"Carotid sinus syncope","volume":"6","author":"Morley, C.A.; Sutton, R.","year":"1984","unstructured":"Morley CA, Sutton R. Carotid sinus syncope. Int JCardiol 1984; 6: 287 - 93.","journal-title":"Int JCardiol"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1002\/ana.410360217","article-title":"Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia","volume":"36","author":"Lempert, T.; Bauer, M.; Schmidt, D.","year":"1994","unstructured":"Lempert T, Bauer M, Schmidt D. Syncope: a videometric analysis of 56 episodes of transient cerebral hypoxia. Ann Neurol 1994; 36: 233-7.","journal-title":"Ann Neurol"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1111\/j.1532-5415.1994.tb06582.x","article-title":"Postprandial hypotension in 499 elderly persons in a long-term health care facility","volume":"42","author":"Aronow, W.S.; Ahn, C.","year":"1994","unstructured":"Aronow WS, Ahn C. Postprandial hypotension in 499 elderly persons in a long-term health care facility. JAm Geriatr Soc 1994; 42: 930-2.","journal-title":"JAm Geriatr Soc"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"489","DOI":"10.1146\/annurev.pu.13.050192.002421","article-title":"Falls among older persons: a public health perspective","volume":"13","author":"Sattin, R.W.","year":"1992","unstructured":"Sattin RW. Falls among older persons: a public health perspective. Annu Rev Public Health 1992; 13: 489-508.","journal-title":"Annu Rev Public Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1016\/0002-8703(92)90507-R","article-title":"Long-term outcome in symptomatic carotid sinus hypersensitivity","volume":"123","author":"Brignole, M.; Oddone, D.; Cogorno, S.; Menozzi, C.; Gianfranchi, L.; Bertulla, A.","year":"1992","unstructured":"Brignole M, Oddone D, Cogorno S, Menozzi C, Gianfranchi L, Bertulla A. Long-term outcome in symptomatic carotid sinus hypersensitivity. Am Heart J 1992; 123: 687-92.","journal-title":"Am Heart J"},{"key":"ref_28","first-page":"419","volume":"80","author":"Kapoor, W.; Snustad, D.; Peterson, J.; Wieand, H.S.; Cha, R.; Karpf, M.","year":"1986","unstructured":"Kapoor W, Snustad D, Peterson J, Wieand HS, Cha R, Karpf M. Syncope in the elderly. Am J Med 1986; 80: 419-28.","journal-title":"Syncope in the elderly. Am J Med"},{"issue":"1","key":"ref_29","first-page":"16","article-title":"The prevalence of carotid sinus syndrome in elderly patients with fractured neck of femur (abstract)","volume":"23","author":"Ward, C.; McIntosh, S.; Kenny, R.A.","year":"1994","unstructured":"Ward C, McIntosh S, Kenny RA. The prevalence of carotid sinus syndrome in elderly patients with fractured neck of femur (abstract). Age Ageing 1994; 23 (suppl 1): A16.","journal-title":"Age Ageing"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1093\/ageing\/16.3.189","article-title":"Prospective study of restriction of activity in old people after falls","volume":"16","author":"Vellas, B.; Cayla, F.; Bocquet, H.; de Pemille, F.; Albarede, J.L.","year":"1987","unstructured":"Vellas B, Cayla F, Bocquet H, de Pemille F, Albarede JL. Prospective study of restriction of activity in old people after falls. Age Ageing 1987; 16: 189-93.","journal-title":"Age Ageing"},{"key":"ref_31","first-page":"137","article-title":"Drug-induced orthostatic hypotension","volume-title":"Syncope in the older patient","author":"Wynne, H.A.; Schofield, S.","year":"1996","unstructured":"Wynne HA, Schofield S. Drug-induced orthostatic hypotension. In: Kenny RA, ed. Syncope in the older patient. London: Chapman and Hall, 1996; pp 137 - 54."},{"key":"ref_32","article-title":"RS More Accepted","year":"1997","unstructured":"RS More Accepted 25 June 1997"}],"container-title":["Postgraduate Medical Journal"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/73\/864\/635\/50223096\/postgradmedj-73-635.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/pmj\/article-pdf\/73\/864\/635\/50223096\/postgradmedj-73-635.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,5,12]],"date-time":"2023-05-12T01:06:09Z","timestamp":1683853569000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/pmj\/article\/73\/864\/635\/7061184"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1997,10,1]]},"references-count":32,"journal-issue":{"issue":"864","published-online":{"date-parts":[[1997,10,1]]},"published-print":{"date-parts":[[1997,10,1]]}},"URL":"https:\/\/doi.org\/10.1136\/pgmj.73.864.635","relation":{},"ISSN":["0032-5473","1469-0756"],"issn-type":[{"value":"0032-5473","type":"print"},{"value":"1469-0756","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[1997,10]]},"published":{"date-parts":[[1997,10,1]]}}}