Wong C W
Department of Medicine and Geriatrics, Caritas Medical Centre, Shamshuipo, Kowloon, Hong Kong.
Hong Kong Med J. 2018 Apr;24(2):182-190. doi: 10.12809/hkmj176945.
Syncope is a prevalent health problem among elderly people. It may be neurally mediated or caused by conditions such as orthostatic hypotension, postprandial hypotension, and cardiac disorders. A combination of different aetiologies is not uncommon in the elderly people. Many pathophysiological processes, including age-related physiological changes, co-morbidities, concomitant medication use, and prolonged bedrest, coexist and predispose elderly people to syncope; advanced age and cardiac syncope are associated with increased mortality. Recurrent syncope and its co-morbidities, such as fall-related physical injury, negative psychological impact, and functional decline, may increase the dependency of elderly patients. Furthermore, the overlap between falls and syncope, and the interaction between syncope and frailty complicate management. Available clinical guidelines for the management of syncope that focus on diagnosis, investigation, and treatment are therefore insufficient to address syncope in elderly patients. A comprehensive geriatric approach that considers an individual's functional and cognitive capacities, as well as medical and psychosocial aspects, would be more appropriate.
晕厥是老年人中普遍存在的健康问题。它可能是神经介导的，也可能由体位性低血压、餐后低血压和心脏疾病等情况引起。在老年人中，不同病因的组合并不少见。许多病理生理过程，包括与年龄相关的生理变化、合并症、同时使用的药物以及长期卧床休息，并存并使老年人易患晕厥；高龄和心脏性晕厥与死亡率增加相关。反复晕厥及其合并症，如跌倒相关的身体损伤、负面心理影响和功能衰退，可能会增加老年患者的依赖性。此外，跌倒和晕厥之间的重叠，以及晕厥和衰弱之间的相互作用使管理变得复杂。因此，现有的侧重于诊断、检查和治疗的晕厥管理临床指南不足以解决老年患者的晕厥问题。一种综合的老年医学方法，考虑个体的功能和认知能力以及医学和社会心理方面，会更为合适。
