title: Syncope in institutionalized elderly: the impact of multiple pathological conditions and situational stress.
abstract: We conducted a prospective study to identify clinical factors which predispose institutionalized elderly to syncope. Over 3 years, 97 patients (mean age = 87 +/- 6 y) developed syncope. On clinical evaluation, diagnoses fell into two categories: specific diseases including myocardial infarction (6%) and aortic stenosis (5%); and situational stresses including drug-induced hypotension (11%), postprandial syncope (8%), defecation syncope (7%) and postural hypotension (6%). Clinical variables derived from the history, physical examination, and laboratory evaluation of these patients were compared to those of 118 non-syncopal age-matched subjects evaluated in similar fashion. Multivariate analysis identified five independent statistically significant correlates of syncope: coronary artery disease (p = 0.0003), functional impairment (p = 0.006), postural blood pressure reduction (p = 0.003), aortic stenosis (p = 0.008), and insulin therapy (p = 0.03). Syncope patients were more likely than controls to have two or more coexistent factors (p = 0.0001). Syncope in institutionalized elderly is often due to the interaction of multiple coexistent clinical abnormalities which impair cardiovascular compensation for common situational stresses.
mesh_terms: D000367:Age Factors; D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications; D002908:Chronic Disease / Q000523:psychology; D003327:Coronary Disease / Q000150:complications; D004562:Electrocardiography; D006707:Homes for the Aged; D006801:Humans; D007024:Hypotension, Orthostatic / Q000150:complications; D007326:Institutionalization; D008134:Long-Term Care; D011446:Prospective Studies; D012044:Regression Analysis; D013315:Stress, Psychological / Q000150:complications*; D013575:Syncope / Q000209:etiology* / Q000503:physiopathology