Causes of Syncope in Elderly Adults

November 25, 2021

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Remember that friend in high school who fainted the day you typed your blood in biology class? Then you are already familiar with syncope. Syncope, or sudden fainting, can happen to anyone at any age. But there is a higher risk of sudden fainting in elderly adults due to their potential other health conditions and danger of serious injury when falling.

Causes of Syncope in Elderly Adults

Dizziness and fainting in elderly adults is caused by a drop in blood pressure and loss of blood flow to the brain. This is called vasovagal syncope and is the most common cause of syncope in elderly adults. For example, if you sit for a long period of time and stand up suddenly, most of your blood has settled to the lower half of your body. Your heart has to work a bit harder to keep the blood flowing up to your brain. This could cause a fainting spell in an elderly adult with a weak heart.

Some other causes of fainting in seniors related to vasovagal syncope include:

• Seeing blood or having blood drawn

• Standing for long periods of time

• Heat exposure

• Anxiety/Intense Emotional Distress or Fear of bodily injury

• Dehydration

Symptoms of Syncope

Knowing what causes syncope in the elderly can help you be aware of your surroundings and avoid triggers that could lead to fainting. But since that is not always possible, it is important to be aware of signs that alert you that you may be about to pass out. These signs include:

If you notice any of these symptoms and are prone to fainting, lie down with your legs elevated above your head to encourage blood flow to your brain. If you can’t lay down, sit with your head between your knees until the feelings pass. While syncope itself is generally harmless, the danger lies in what is going on around you when you faint. For example, you don’t want to hit your head as you fall or have a fainting spell at the top of the stairs.

There is no true syncope treatment for elderly adults – more symptom management, as mentioned above. Your doctor may run some tests to see if the fainting spells are an indicator of a more serious cardiovascular condition such as cardiomyopathy. It is most important to be aware of the condition and notice if an episode is approaching so you can stay safe.

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Seniors and Syncope: The 411 on Fainting

If you’ve ever been around someone who has fainted—or if you’ve ever fainted yourself—you know it’s a frightening ordeal. Clinically known as “syncope” (pronounced SIN-co-pee), fainting is not only much more common in older adults but also associated with a reduced survival rate—and therefore of particular importance for senior caregivers. Here’s a closer look at syncope, along with what all caregivers need to know about caring for someone with this condition.

About Syncope

According to “Syncope in Older Adults” published in the academic journal Geriatrics and Aging, “Syncope is defined as a transient and sudden loss of consciousness with a loss of postural tone. Patients with syncope constitute up to three percent of all emergency visits and one to six percent of all hospital admissions in North America. Patients over 70 years of age have a much higher rate of syncope than their younger counterparts and represent the majority of patients hospitalized with syncope. Unless it is vasovagal, syncope is related to decreased survival.”

When people experience syncope—or “faint”—they lose consciousness and become unresponsive while their muscles go slack. Prior to this, some people feel dizzy or hear a buzzing sound in their ears. While most people recover spontaneously on their own from a fainting episode, there is cause for concern for several reasons. For starters, syncope is not a disease in itself but may be indicative of a more serious problem. Additionally, injuries can occur during the episode. 

What Causes Syncope?

Syncope results from a temporary loss of blood flow to the brain. While some causes are harmless, in other cases it can be life-threatening. In seniors, orthostatic hypotension (a sudden drop in blood pressure) reflex syncope (a side effect of carotid sinus syndrome), and heart disease are the most common causes of fainting. Conditions of the brain and nervous system, dehydration, and polypharmacy are all associated with syncope, according to HealthinAging.org. 

If someone for whom you’re caring has a fainting spell, immediate follow-up with his/her healthcare team is important as this can help determine any potentially dangerous underlying conditions. Based on a physical exam and patient history, the healthcare team will identify the most appropriate tests aimed at determining the cause of the episode. Tests may include blood pressure measurement, evaluations for heart disease, and a “tilt-table test,” which tracks changes in symptoms in positions ranging from lying down to upright. 

In some cases, the provider will not be able to ascertain the cause. While this can be disconcerting, it’s also good news as it most likely means the condition is not severe. 

Syncope Treatment and Management

Because syncope has many causes, treatments are equally diverse. In some cases, it may be as simple as making changes to medications, while heart-related factors may mandate aggressive medical interventions, such as a pacemaker. 

When syncope is caused by orthostatic hypotension, the healthcare provider may recommend simple changes to reduce the risk of fainting, including wearing compression stockings, sitting for a while and/or exercising your legs before getting up in the morning, elevating the head of the bed, and increasing salt intake. Furthermore, if your aging loved one’s syncope is linked with a certain “trigger,” avoiding these can also mitigate the risk of fainting episodes. 

If someone for whom you’re caring starts experiencing syncope, some lifestyle changes may also be in order. Depending on the circumstances and the laws of the state in which you live, driving may also be prohibited. Additionally, avoiding stairs and hard surfaces and implementing basic fall prevention precautions can reduce the risk of sustaining injuries during an episode. 

mmLearn.org offers a large library of free videos for caregivers of older adults, covering topics pertaining to senior care. Whether you are a healthcare professional or a family caregiver, if you are caring for an older adult we know that you will find mmLearn.org an essential learning and guidance tool for all of your caregiver training needs. For more free caregiver training materials, access our database of free online caregiver videos today.

An aging person: about what happens to us with age

An aging person: about what happens to us with age

What is an aging person and what is a developing person? The article focuses not on biochemical and morphological aspects, but on the personality – on the process of individual development of a person, because it never stops. There is no need to think that after adolescence, a person reaches a plateau, as scientists call “acme”, the highest point of development, and then degrades. Aging is not degradation. This is a process of continuing development, a very peculiar one.

Normal aging, according to our psychological school, is a process of continuous, progressive, uneven, complex growth of various limitations. There are purely physiological ones: hearing is reduced, specific forms of diseases appear that are not actually diseases, but there are normal symptoms of aging associated with movements, muscles, sensory systems, psychology, and so on, and, of course, social restrictions arise that are in the individual consciousness of an aging person are refracted and turn into existential ones. The unevenness of the process gives rise to individual differences. Modern methods of scientific research, prone to statistical processing and quantitative analysis of data, unfortunately, do not help to reveal the essence of the mechanisms that lie behind it, because aging is extremely individual.

Why? Speaking rather roughly, here is a child. As soon as he is born, he immediately enters the society where he is looked after, but nature is arranged in such a way that a certain program is laid in the genetics of a new person that gives him a minimum range so that he survives. Therefore, early ontogeny, that is, early individual differences from birth to preschool age, is sufficiently programmed. We know the standards: when a child should be able to hold his head, say the first word, what kind of words should be, when he should have phrasal speech, when he should start walking, crawling, and so on. If there are deviations in the standards, we say that this is abnormal, pathological, something needs to be done about it – the correction should be medical, because these programs are biological. In adulthood, development is already more directed, social: a person shows his own activity, and so on. He reaches the third age, that is, the age of aging, with already very serious baggage – knowledge, experience, experiences, psychological trauma, views, meanings, values. All this colossal baggage, of course, makes the natural biological program very noisy. Therefore, aging is individual precisely because of individual experience. Thus, we are not very good at finding biological causes using natural science methods. Therefore, all the data on individual differences that I will give are clinical. That is, collected not on patients, but through long-term, many years of observation – including our department and me.

Nevertheless, it is possible to distinguish individual differences, which we call style, variant or type, that is, to distinguish a certain typology of normal aging based on how the brain works. In the 1930s and 1950s, a prominent Soviet researcher, psychologist Alexander Romanovich Luria, discovered the science to the world, which he called neuropsychology. She was born in the Soviet Union and is accepted all over the world. Indeed, this is our achievement, one of the few that is definitely ours. Luria studies patients with local lesions of the brain, presenting various kinds of tests, showing that when certain structures are damaged, certain symptoms of violations of higher mental functions arise, such as memory, thinking, attention, speech, and so on. He concluded that if a patient is given a certain test that will demonstrate certain disorders of mental functions, then these zones are responsible for the implementation of these mental functions.

In the 1970s and 1980s, Natalya Konstantinovna Korsakova, a student of Alexander Romanovich Luria, began working at the Mental Health Research Center, where she was offered to use the methods developed by Luria to diagnose Alzheimer’s disease in order to understand exactly how the brain is affected. And indeed, by presenting these tests, the Lurian methods that were developed for people with brain tumors, she shows that patients with Alzheimer’s disease experience very similar symptoms, similar to those that occur in patients with tumors of the parietal, frontal lobes. , temporal, subcortical structures of the brain. Korsakova concludes that in Alzheimer’s disease and other forms of senile dementia, severe mental disorders of senile age, specific cognitive impairments are observed. This means that this pathological process, not tumorous, but atrophic, spreads in each individual case with a different disease to certain areas of the brain. This is how the science of neurogerontopsychology is born. Scientists became interested in what happens in old age in the norm. Having studied more than 300 healthy people from 50 to 100 years old who have never visited doctors for mental health and neurological problems, Korsakova identifies various neurocognitive styles, a typology of normal aging. It shows how we and our psyche are aging in connection with the work of the brain. These data are indirectly confirmed by Western studies using neuroimaging, functional tomography, positron emission tomography, and so on.

What is aging phenomenologically?

First, of course, this is a slowdown in the pace of activity. Latency is growing, people at the third age begin to work more slowly. This slowness becomes especially evident at the initial stage of activity. It becomes especially difficult to quickly extract information, to link it. You need to be able to negotiate with your memory after 55 years, so that it gives out what you need.

Secondly, the person begins to work as a single-channel system. If he reads a newspaper, then the TV no longer hears and does not think about things that are not related to this newspaper.

As for the speech sphere, an elderly person should speak not only slowly, but also in a low voice. Not necessarily loud, although age-related hearing loss can also occur, but a velvety baritone or even bass will be learned better than tenor and falsetto. This is a purely sensory thing, scientifically proven.

Fourth, tempo characteristics. Speech information can be absorbed more slowly than non-verbal information. There is a certain imbalance, stealing the right hemisphere in favor of the left. The left hemisphere begins to work more intensely due to the fact that it may lose some right hemisphere functions. But nevertheless, not always and quite fragmentarily, therefore, for example, music is assimilated well, and listening to songs of youth actualizes the deep layers of memories.

The tactile sphere literally comes to life, that’s why people love sorting things, dusting, so it’s better to give the elderly textured gifts, textured ones – this also actualizes the thresholds of memory layers.

About memory. Access to direct memories of what happened now is becoming more closed. Access to early memories of youth, youth and even childhood is opened. They become brighter and more distinct. Traces of memory are not erased: we remember everything, we just do not always have access to it.

And finally, this is a decrease in the ability to learn new things and difficulties in setting creative tasks. Not because the person becomes demented, but because there is not enough energy to keep the creative process going, which, as you know from all the metaphors, must gusher.

Types of normal aging

This typology is based on the concept of Alexander Romanovich Luria about the structures of the functional blocks of the brain. On the basis of his numerous studies, he divided the brain into three blocks not according to the morphological structure, but according to the roles that brain structures play for the implementation of higher mental functions.

Energetic neurocognitive style of aging

The most common, universal. It is associated with a decrease in the functions of the energy supply of mental activity: people become slower, they experience the “on-off” phenomenon – “on-off”. That is, a person starts reading a book, it’s difficult, it’s not vulgar, he closes it, goes to the kitchen and helps his wife cook borscht, that is, it is activated. These fluctuations can be observed quite gently, they should not disturb the adaptation. With vascular lesions of the brain, this effect can disrupt it. That is, a person may not cope with the task in the “off” state, and in the “on” state, he may become too excited. He cries, he laughs. There are such clinical examples.

In addition, this is a narrowing of the volume of activity, a single-channel system of perception, slowness of memory traces and fatigue – non-specific characteristics of aging, not risk factors. The most important thing is that the cerebral cortex works well. That is, a person can come up with it himself, learn from past experience, plan, for example, that it will take him such a long time to get to the clinic, and in order to visit his grandchildren, such operations are needed; he can plan the day in a specific way. Inhibition, the inaccessibility of memories that are needed right now, means that you need to write it down, and a person understands all this. The risk factor that can lead a person to maladjustment is, of course, stress. Since the subcortical structures are emotions, stress resistance, the ways to regulate one’s emotions become insufficient. That is, there may be emotional problems.

This is also an exacerbation of bodily ailments. The most malignant one, which really unsettles a person and puts him into a state of disadaptation, anxiety, depression, is the femoral neck. Such a person needs special attention; perhaps professional psychological support. I’m not talking about cataracts and other purely age-related things – they, of course, also require special attention.

Spatial neurocognitive style of aging

The second type is a decrease in the ability to orientate in real and internal space. Already a specific type of aging, in which it becomes very difficult to holistically perceive various things. Reading even a short story and understanding what the point is can already become a problem. You must first read one paragraph, comprehend it, remember it, take a breather, then the second and so on. Technically, you can read a story, a person will not be exhausted, but he will not understand it. And the most important thing is “disadaptation” in the new space. Please note this is not a spelling error. That is, the person is not completely lost, but it is difficult for him in the new space, he begins to grab his right hand, thinking: “The right hand means I need to go to the right.” They have a marker that is actually programmed: “I write with my right hand,” which means you need to orient yourself to the right. They can stray for a very long time, but not in the sense that they are really lost, but because they have such difficulties in a new space. In the old familiar space, everything can be quite safe.

That is, the risk factors here are a change in the environment, for example, emigration. Our colleagues, Russian psychologists abroad, at one time published articles in journals devoted to Russian emigrants in France and the USA. They describe these phenomena on a very large scale, also in connection with the linguistic side. For example, the phenomenon of “pathological nostalgia”: an emigrant woman believed that she was in her Moscow apartment, she saw people from that life. These were not hallucinations due to mental illness, but a temporary condition, stress, culture shock. It has to do with the right hemisphere.

The important thing to understand here is that these kinds of things can be very similar to Alzheimer’s disease, but they need to be distinguished. Here are the statistics. Schizophrenia is 1%, but 10% is Alzheimer’s disease, where 4% is early Alzheimer’s. In our clinic, these are all women 40 years old. I remember the last case: 40 years old, a nurse and really severe symptoms associated with profound memory impairment. If you want to understand what it is, watch the amazing film “Still Alice” about early Alzheimer’s. What happens to a person is shown with maximum reliability, with deep psychologism, insight into the essence of this painful condition. After 55–60 years old, this is already classic Alzheimer’s, and the later one is called senile (lat. “senile”). Scientists say it’s genetically programmed. Unfortunately, there are no methods to identify a person’s risk of developing this disease before the disease occurs. The genetic constellation leads to an imbalance of acetylcholine and other neuropeptides, which leads to the formation of Alzheimer cells, that is, atrophy of nerve cells in certain departments, which leads to the fact that these cells do not work and the brain functions poorly.

There is no cure for Alzheimer’s disease: all drugs that are prescribed are symptomatic and do not significantly improve the state of mental functions. And even more so, unfortunately, they do not prevent further malignant development (after the onset of the disease, a person lives no more than 10 years). This is gross exhaustion, that is, a person cannot actively work for 45 minutes, gross memory impairment, inability to remember material, spatial orientation disorder, confusion, that is, a person may not understand where he is, on the street or at home. You could once watch a grandfather in slippers on the street with an absolutely bewildered expression on his face, who sometimes screams, tries to call for help. Of course, this is not yet a reason to diagnose him with Alzheimer’s disease, but this is a pathological condition that very often accompanies it. Spatial disturbances come to the fore, that is, people cannot remember where the toilet is, where the kitchen is. But it is worth noting that their facade of personality is preserved, they experience this state, they are critical of it. Perhaps the whole tragedy lies in the fact that they understand that they are losing what makes up their personality. Because, according to one of the founders of Russian psychology, Sergei Leonidovich Rubinshtein, one of the central functions of memory is the structuring of personality. If memory disintegrates, all our experience disintegrates, the experience of communication with our personality, that is, the personality leaves.

Regulatory neurocognitive style of aging

This is not yet a pathology, but it is already a truly risky option when the anterior parts of the cerebral hemispheres age first. This is where self-control comes in. This is the most central symptom as the frontal lobes are involved. Luria calls the third functional block of the brain a block of programming, regulation and control of mental activity, therefore here regulation and control suffer first of all. When they weaken a little, this is still the norm – what we in everyday life call “gray hair in a beard, demon in a rib”: a person is over 60, and he believes that he, as a young man, can do his job, behave like a young man, dress in torn jeans, walk with a player, say: “I listen to Dima Bilan, I won’t listen to Shulzhenko and Utyosov, I’m not that old yet. ” There may also be sexualization of behavior.

In activities there may be problems with building plans, getting stuck at some points, inflexibility. Apathy, disturbance and decrease in motivation, which must still be preserved. Including the motivation to transfer semantic value experience to other generations: “Well, why should I call my grandson, he doesn’t need me. That I will get him.” Experience of failure, loneliness, changing living conditions – all this can be a risk factor. Emotional, brutal reactions may follow. Against the background of stress, an elderly person may think: “What is it, my son came, he stole my passport. I can’t find my passport, because he came, he wants to do something with me.” That is, crazy ideas arise, but against the background of some kind of stress.

The extreme case, the pathological prototype here is Pick’s disease – also a classic disease, the pole of Alzheimer’s disease. If the facade of the personality is preserved there, and the person is aware of and suffers from increasing cognitive impairment, then in Pick’s disease (or, as it is now customary to say according to the newfangled psychiatric classification, in frontotemporal dementia), the anterior sections of the cerebral cortex are dysfunctional. Such patients are emotionally blunted, passive, indifferent, inactive, lying down, doing nothing. They are impoverished in motor skills, writing, reading, counting and are not critical of what is happening, but they are euphoric, they are complacent, they can laugh. At the same time, they are absolutely inactive, empty, moral and ethical attitudes are lost. There may be stereotypes, perseverations, that is, obsessive actions, and gross cognitive impairments, that is, speech disorders, grammatical structure, impoverishment of speech production, unwillingness to speak, build a detailed statement, and so on. First of all, and at the beginning, this emotional and personal dysfunction appears, at a later stage, some cognitive impairments are added. Now this is maladjustment.

What prevents pathological aging?

People who have been engaged in intellectual work throughout their lives suffer from dementia of late age less. Gymnastics technologies for the brain have been developed separately, that is, if there are already some limitations in the cognitive sphere, then you can turn to psychologists who will develop an individual training program. Of course, I know old people who learn poetry themselves. It’s like a separate activity: we got up, had breakfast, walked the dog, then a couple of hours to learn a new poem, called a friend in the Moscow region, read it by heart, played chess on the phone, which is also good, you can see how e2-e4 correlate, then you can eat again, then walk the dog again. That is, it is a planned activity, where there is a cognitive and intellectual component to maintain tone. The tone is maintained in this way – through intellectual activity.

In people who constantly maintained physical activity, the risk of dementia of late age decreases due to the fact that the metabolism works better, which means that atherosclerotic plaques do not form, sugar normalizes, and so on. That is, things that are purely connected with the vessels no longer make a pathological contribution.

Mode. It has been shown that people who drink alcohol are more likely to suffer from dementia of late age. The so-called Mediterranean diet is useful: proteins, seafood, phosphorus, fresh vegetables. Those who have a clear pattern of sleep and wakefulness get sick less.

And then pure psychology. People who experienced psychotraumas and did not turn to a specialist with these psychotraumas, did not get rid of them, suffer more often. People who experienced a lot, but mini-stress, that is, who had vigorous activity, who lived in constant stress, suffer less from Alzheimer’s disease and other dementias.

Reflective people (who reflect on their inherent neurocognitive style) can use this. As in the example with borscht. If he has a spatial option, but he remembers well which ingredients to put. And she has the first option, she doesn’t remember it, but her frontal lobes are intact, that is, she remembers the procedure: first you need to pass, then lay out, and so on. And now they cook borscht together, because they understand that it is impossible to cook it not together. That is, they really bring freshness to their relationship, because they go to a new level. They form a joint activity, which was not.

And finally, the possibility of realizing development goals. Of course, you understand very well: those old people who have grandchildren are happy. Loneliness gives rise to all these forms of maladjustment. Even if we have a lonely representative of the third age, but he has all this (that is, he was intellectually active, he reflects on what is happening to him), then he will be able to find compensation strategies through purely social things like clubs or social programs.

Elderly person

As an African proverb says: “When an old man dies, the whole library disappears.” This proverb may sound differently in different countries, but its meaning is the same in any culture. Older people are mediators between the past, present and future. Their wisdom and experience form the basis of any society.

Older people are those over sixty. Elderly people are one in five of us.

Older people are what we will become in thirty, twenty or ten years.

These are our grandparents, mothers, fathers, uncles and aunts.

Elderly people are those who have a clear feeling that strength is decreasing every day, and infirmities are multiplying, and that this process is irreversible.

One of the requirements of human morality is respect for the elderly and concern for the older generation. Some families have problems in relationships with older people. Sometimes conflicts become so serious that it is impossible to live together. Why is this happening? What is the reason for these conflicts? Or in whom…? Why do some old people create problems for family members and for themselves, reproach their families for not taking care of them, not loving them …. After all, nothing just happens.
Have you noticed that young children and older people get along well? They enjoy spending time together: walking, playing. This is because toddlers have a positive perception of older people.
And in youth and more mature age, the attitude towards the elderly is more critical. Sometimes even negatively. Although it would seem that the energy of youth, the experience and wisdom of old age should complement each other and go side by side.
In old age, people usually take stock of their lives. And here it is very important what conclusion a person comes to. If at work, in the family he achieved good results, for which he feels pride, joy, then, of course, self-confidence will be an important source of normal relations in the family. If an elderly person rejoices in the achievements of children (whether in professional activities, be it in family life), if they are respectful towards others, hardworking, then it is from this source that he will draw strength for life.
But there is another category of older people, for whom everything is exactly the opposite. Moreover, plus to everything, – problems with health. How to be it, how to spend the rest of the years in harmony with oneself and with the environment? What if, having lived for many years with your soulmate, after her death, the feeling of loneliness does not leave, if, having devoted your whole life to children, you do not receive due attention from them? Of course, it’s hard with a closed, uncommunicative, suspicious person, who all the time reproaches you for inattention, sometimes threatens you with moving, leaving the family. Of course, such an elderly person in the house means care, care and patience, and only next to his grandchildren and children can his life be filled with meaning.
Old people tend to have a lot of free time, unlike young people. After all, our parents are used to working, any inaction is unacceptable for them. And the task of the family is to help with something to occupy this free time. You can, for example, entrust a walk with your grandson (this is useful, and the child will be delighted to communicate with his grandmother or grandfather) or ask him to knit warm mittens or a scarf for children. Or maybe just ask to tell a fairy tale, prepare the children for bed (you must admit, sometimes you want someone to do it for you).
With age, a person is drawn to the earth, and working in the garden or in the garden, growing vegetables or flowers brings great satisfaction to our old people.
In the traditions of any nation, including Russian, is the veneration and respect for elders.