Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Aug;25(8):880-890.
doi: 10.1111/acem.13414. Epub 2018 Apr 23.

Outcomes of Patients With Syncope and Suspected Dementia

Affiliations

Outcomes of Patients With Syncope and Suspected Dementia

Timothy R Holden et al. Acad Emerg Med. 2018 Aug.

Abstract

Objectives: Syncope and near-syncope are common in patients with dementia and a leading cause of emergency department (ED) evaluation and subsequent hospitalization. The objective of this study was to describe the clinical trajectory and short-term outcomes of patients who presented to the ED with syncope or near-syncope and were assessed by their ED provider to have dementia.

Methods: This multisite prospective cohort study included patients 60 years of age or older who presented to the ED with syncope or near-syncope between 2013 and 2016. We analyzed a subcohort of 279 patients who were identified by the treating ED provider to have baseline dementia. We collected comprehensive patient-level, utilization, and outcomes data through interviews, provider surveys, and chart abstraction. Outcome measures included serious conditions related to syncope and death.

Results: Overall, 221 patients (79%) were hospitalized with a median length of stay of 2.1 days. A total of 46 patients (16%) were diagnosed with a serious condition in the ED. Of the 179 hospitalized patients who did not have a serious condition identified in the ED, 14 (7.8%) were subsequently diagnosed with a serious condition during the hospitalization, and an additional 12 patients (6.7%) were diagnosed postdischarge within 30 days of the index ED visit. There were seven deaths (2.5%) overall, none of which were cardiac-related. No patients who were discharged from the ED died or had a serious condition in the subsequent 30 days.

Conclusions: Patients with perceived dementia who presented to the ED with syncope or near-syncope were frequently hospitalized. The diagnosis of a serious condition was uncommon if not identified during the initial ED assessment. Given the known iatrogenic risks of hospitalization for patients with dementia, future investigation of the impact of goals of care discussions on reducing potentially preventable, futile, or unwanted hospitalizations while improving goal-concordant care is warranted.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest Disclosure:

TRH reports no conflict of interest

MNS reports no conflict of interest

TAG reports no conflict of interest

REW reports no conflict of interest

ANY reports no conflict of interest

SEM reports no conflict of interest

DHA reports no conflict of interest

AB reports no conflict of interest

CWB reports no conflict of interest

JMC reports no conflict of interest

CLC reports no conflict of interest

DBD reports no conflict of interest

JEH reports no conflict of interest

BAN reports no conflict of interest

DKN reports no conflict of interest

KAS reports no conflict of interest

ABS reports no conflict of interest

STW reports no conflict of interest

BCS reports no conflict of interest

Similar articles

Cited by

References

    1. de Ruiter SC, de Jonghe JF, Germans T, Ruiter JH, Jansen RW. Cognitive impairment is very common in elderly patients with syncope and unexplained falls. J Am Med Dir Assoc. 2017;18(5):409–13. - PubMed
    1. Rudolph JL, Zanin NM, Jones RN, et al. Hospitalization in community-dwelling persons with Alzheimer’s disease: frequency and causes. J Am Geriatr Soc. 2010;58(8):1542–8. - PMC - PubMed
    1. Sun BC, Emond JA, Camargo CA., Jr Characteristics and admission patterns of patients presenting with syncope to U.S. Emergency Departments, 1992–2000. Acad Emerg Med. 2004;11(10):1029–34. - PubMed
    1. Galizia G, Abete P, Mussi C, et al. Role of early symptoms in assessment of syncope in elderly people: results from the Italian Group for the Study of Syncope in the Elderly. J Am Geriatr Soc. 2009;57(1):18–23. - PubMed
    1. Ungar A, Mussi C, Ceccofiglio A, et al. Etiology of syncope and unexplained falls in elderly adults with dementia: Syncope and Dementia (SYD) Study. J Am Geriatr Soc. 2016;64(8):1567–73. - PubMed