Date of Award

5-4-1995

Document Type

Open Access Thesis

Degree Name

Medical Doctor (MD)

First Advisor

Dr. Mary Tinetti

Abstract

Syncope is a serious but potentially preventable occurrence commonly afflicting the elderly population. The objectives of this study were to estimate the incidence of syncope in the community-dwelling elderly population, to identify the clinical risk factors that predispose some elderly persons to syncope, and to describe situational factors and the morbidity associated with syncope. Study participants were members of the Project Safety cohort, representing a probability sample of non-institutionalized residents of New Haven, Connecticut aged 72 years or older. Age-restricted housing lists and utilities listings were used to generate an index of community dwellings from which 5,936 households were identified. Baseline interviews identified 1,436 eligible persons. From this group, 1,103 people were followed for a syncopal episode for a two year period. Syncope occurred in 6.3% of the subjects over the two year period. Many diverse baseline characteristics were associated with an increased risk for syncope including the presence of several chronic conditions, a history of syncope or dizziness, the use of certain medications, and impaired functional status. Clinical risk factors independently associated with syncope included a history of dizziness when rising from the sitting position (adjusted odds ratio 3.1; 95% confidence interval 1.6, 6.1), a history of syncope in past year (2.4; 1.1, 5.2), the use of glycosides, nitrates and/or calcium channel blockers (2.2; 1.3, 3.7), slow gait speed (1.5; 0.9, 2.7), and age >78 years (1.5; 0.9, 2.6). Soft tissue injury was the most often reported injury while fractures were associated with 9.9% of syncopal events, representing 16% of those episodes associated with some injury. A multifactorial model for the etiology of syncope appears to best explain the occurrence of syncope in the elderly population. Therefore, a multidimensional risk strategy to stratify patients into different risk groups will enable directing risk reduction practices toward those patients who may most benefit.

Comments

This is an Open Access Thesis.

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