Characteristics of syncopal falls in community-living older people transported to an emergency department

In older people, falls are major reasons for transporting to emergency departments (ED). Falls are etiologically classified into syncopal falls and non-syncopal ones. The aim of this study is to clarify the characteristics of syncopal falls in community-living older people transported to ED. The retrospective chart review was performed on patients older than 65 years, transported to the ED of Keio University Hospital in Tokyo because of falls during a 12-month period. Age, sex, blood pressure and pulse rate at the arrival to ED, episode of syncope, type of fall, sustained injury and medical problems were screened. We analyzed the differences between syncopal falls and non-syncopal ones. Patients with syncopal falls were given blood tests, electrocardiograms, and standing tests for orthostatic hypotension. The number of syncopal falls was 33 (29.5%), and that of non-syncopal ones was 79 (69.3%). Syncopal falls frequently occurred on same level compared with from one level to another (84.8% versus 9.1%). In patients with syncopal falls, the frequency of falling on the same level was significantly higher than that in patients with non-syncopal falls (84.8% vs 60.8%). Patients with syncopal falls significantly sustained fewer fractures (12.1% vs 34.2%), and used more antihypertensive agents (45.5% vs 18.9%) than those with non-syncopal ones, respectively. The 14 syncopal fall patients were given standing tests, and four patients presented orthostatic hypotension. In community-living older people transported to ED, syncopal falls frequently occurred on the same level, and the patients with syncopal falls were found to have sustained fewer fractures and use more antihypertensive agents.