Syncope is a common cause of presentation to the emergency department in the older population, who are at increased risk of syncope resulting in serious injury in the form of fractures, adverse cardiac outcomes and death, lack of confidence and mental health issues. Older patients can present diagnostic challenges due to multiple co-morbidities, polypharmacy and the problem of amnesia associated with transient loss of consciousness. The underlying cause of their syncope can be established through a structured approach, and targeted patient selection can limit inappropriate investigations in syncope assessment units and ensure appropriate treatments are instituted. A previous review article in this journal, by Nath and Kenny in 2005, examined the evidence surrounding various aspects of syncope, including prevalence, cause, risks, investigations and treatment. This review updates the evidence and guidelines on the aetiology, investigation and treatments of syncope in the older person, with emphasis on recent advances.

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