Geriatrics
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Syncope is a transient loss of consciousness and postural tone, with spontaneous recovery, and may represent an episode of aborted cardiac arrest. The final common pathway for loss of consciousness from non-neurologic causes is hypoperfusion of the reticular activating system. The etiology of syncope in older patients frequently includes a myriad of causes (e.g., orthostatic hypotension, medication side effects, sick sinus syndrome, atrioventricular block, carotid hypersensitivity, ventricular tachycardia, and aortic stenosis). ⋯ Echocardiography, electrophysiology testing, and head-upright tilt table testing will confirm the diagnosis in most of the remainder. Approximately 25% of patients will have no identifiable cause of syncope, but have a better prognosis than patients with a confirmed cardiac cause of syncope. Treatment is directed at the underlying cause.
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Dizziness is one of the most common complaints among patients age 50 and older who present to primary care physicians. The evaluation of dizziness is challenging due to the wide range of diagnostic possibilities, including four symptom categories each with multiple potential underlying causes. ⋯ These strategies include use of medications to control acute vestibular and autonomic symptoms as well as vestibular rehabilitation exercises. Difficult cases that do not respond to treatment efforts should be referred to an otolaryngologist for further evaluation and treatment.
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Sleep disorders may affect one out of two older Americans and may present as insomnia, excessive daytime sleepiness, or both. Age-related changes seem to cause a decreased need for sleep. The average 70-year-old sleeps only 6 hours a night, but may obtain an additional hour or even 2 during daytime naps. ⋯ The two most common geriatric sleep disorders are obstructive sleep apnea syndrome and restless legs syndrome. Detailed diagnostic workup and treatment are usually referred to a center for sleep medicine where polysomnographic studies are performed. Left untreated, sleep disorders may present a serious threat to the patient's health and lead to increased morbidity and mortality.