• Andrea Ungar, Alice Ceccofiglio, Chiara Mussi, Mario Bo, Giulia Rivasi, Martina Rafanelli, Anna Maria Martone, Giuseppe Bellelli, Franco Nicosia, Daniela Riccio, Virginia Boccardi, Elisabetta Tonon, Francesco Curcio, Francesco Landi, Pasquale Abete, and Enrico Mossello.
• Department of Medicine and Geriatrics, Syncope Unit, University of Florence and Azienda Ospedaliero Universitaria Careggi, Largo Brambilla, Florence 50139, Italy. Electronic address: aungar@unifi.it.
• Eur. J. Intern. Med. 2022 Apr 1; 98: 93-97.

ObjectiveTo compare one-year mortality risk associated with syncope and unexplained fall in older adults with dementia.Methods522 patients (aged >65 years) with dementia and history of transient loss of consciousness and/or unexplained falls were evaluated. The diagnosis of syncope was based on European Society of Cardiology guidelines. A "Syncopal Fall" was defined in patients with an initial clinical presentation of unexplained fall, but a final diagnosis of syncope after complete assessment. A "Truly Unexplained Fall" was defined in patients with an initial clinical presentation of unexplained fall, in whom a diagnosis of syncope had been excluded after the diagnostic work-up. One-year follow-up was assessed by phone interview.ResultsFollow-up data were available for 501 participants (mean age 83 ± 6 years, 65% female). After a mean follow-up of 324 ± 93 days, death from any cause was reported in 188 participants (24%). Advanced age, male sex, cognitive and functional impairment were associated with a higher mortality rate. Patients with "Truly Unexplained Falls" had a higher mortality risk compared with syncope and "Syncopal Fall". A diagnosis of "Truly Unexplained Falls" remained an independent predictor of one-year all-cause mortality in multivariate model.ConclusionsWe propose the novel diagnostic category of "Truly Unexplained Fall", resulting from the application of syncope guidelines to subjects with unexplained falls. This condition in older adults with dementia is a predictor of one-year all-cause mortality. For this new high risk profile, we advice a comprehensive geriatric assessment focused on risk factors for fall, aimed at a possible improvement of prognosis.Copyright © 2022. Published by Elsevier B.V.

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