title: Syncope and near-syncope as a multifactorial problem in geriatric inpatients: Systemic hypotension is an underrated predictor for syncope exclusively.
abstract: OBJECTIVE
  Syncope (SC) and near-syncope (NS) are still misunderstood syndromes. Aim of study was to determine the risk factors for SC, NS, as well as for both entities (SC/NS) in geriatric inpatients reporting these events within the last year, irrespectively of the reason of admission to hospital.
  
  
  METHODS
  The retrospective study covered 250 patients, consecutively admitted to the geriatric ward. Patients were assigned to the three models: SC and/or NS in total, n=106; isolated NS, n=72; SC with co-existing NS, if any, n=34, and compared with patients without any such events (n=144). The patients underwent a comprehensive geriatric assessment and complete clinical investigation. The binary logistic regression was applied to predict risk factors for each of the models.
  
  
  RESULTS
  Falls were most predictive for NS model (OR 35.4; 95% CI 10.3-121.1), and systemic hypotension for SC model (OR 92.9; 95% CI 6.1-1421.0). The highest specificity (85%) and sensitivity (81%) were found for the SC/NS model, with the highest contribution by falls (OR 18.1; 95% CI, 7.6-45.2), orthostatic hypotension (OR 8.1; 95% CI, 3.5-18.5), a history of stroke or transient ischemic attack, treatment with an angiotensin receptor blocker, plasma creatinine >1.4mg/dL, negatively self-rated health, vertigo, pathology of carotid arteries, and lack of hypertension.
  
  
  CONCLUSIONS
  Syncope and near-syncope in geriatric inpatients have multifactorial and cumulative aetiology, with blurred, frequently overlapping boundaries between them. The falls, postural hypotension, and/or brain hypoperfusion of different origin seem to be most predictive of the both events, however low systemic blood pressure was predictive for the syncope exclusively.
authors: Department of Geriatrics, Medical University of Bialystok, Bialystok, Poland. bien@umwb.edu.pl
authors: B
authors: B
authors: Bień
authors: J
authors: J
authors: Wilmańska
authors: W
authors: W
authors: Jańczak
authors: A
authors: A
authors: Wojskowicz
authors: A
authors: A
authors: Kasiukiewicz
authors: K
authors: K
authors: Klimiuk
authors: M
authors: M
authors: Toczyńska-Silkiewicz
authors: E
authors: E
authors: Gułaj
authors: B
authors: B
authors: Kuprjanowicz
mesh_terms: D000058:Accidental Falls; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D005260:Female; D005853:Geriatrics / Q000379:methods; D006760:Hospitalization; D006801:Humans; D007022:Hypotension / Q000175:diagnosis* / Q000473:pathology; D007024:Hypotension, Orthostatic / Q000175:diagnosis* / Q000473:pathology; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013575:Syncope / Q000175:diagnosis* / Q000503:physiopathology*