1. 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
2. Syncope: an accurate history tells all;Petch, M.C.;BMJ,1994
3. Carotid sinus syndrome - clinical characteristics in elderly patients;Kenny, R.A.; Traynor, G.;Age Ageing,1991
4. Outcome of an integrated approach to the investigation of dizziness, falls and syncope in elderly patients referred to a 'syncope' clinic;McIntosh, S.; Da Costa, D.; Kenny, R.A.;Age Ageing,1993
5. Clinical characteristics of vasodepressor, cardioinhibitory and mixed carotid sinus syndrome in the elderly;McIntosh, S.J.; Lawson, J.; Kenny, R.A.;Am Jt Med,1993