Fainting in elderly people: what to know and do

Fainting, also called syncope, is a brief loss of consciousness caused by temporarily reduced blood flow to the brain. A person may feel warm, sweaty, light-headed, or nauseated first, although a sudden collapse can happen without warning.

Common triggers include standing up quickly, prolonged standing, heat, pain, emotional stress, and not drinking enough. Medicines for blood pressure or other conditions can also contribute by lowering blood pressure or changing the heart rate. An older person may have more than one factor at the same time.

Fainting can also occur with anaemia, dehydration, or hypoglycaemia. A heart rhythm problem such as atrial fibrillation may need consideration, particularly when the episode occurs during exertion, starts without warning, or comes with palpitations. The event itself does not identify the cause, so details from a witness are valuable.

Lay the person flat and raise their legs if there is no injury that makes this unsafe. Loosen tight clothing, check that they are breathing normally, and keep the area clear. Do not give food, drink, or tablets until they are fully awake and able to swallow. Turn them on their side if they are vomiting or not fully alert, and stay with them.

After recovery, help them sit up slowly, then stand only with support. Note what they were doing, their position, warning symptoms, possible injury, duration of unresponsiveness, movements, and confusion afterward. Arrange medical review even if they seem well, especially after a first episode or a fall.

Call emergency services if the person does not wake promptly, is not breathing normally, has severe chest pain, marked breathlessness, a new one-sided weakness, trouble speaking, a serious injury, or ongoing seizure-like movements. Seek urgent assessment for fainting during exercise, while lying down, or with a racing or irregular heartbeat.

Urgent review is also appropriate when there is repeated fainting, persistent confusion, black or bloody stools, significant bleeding, or a fall with head, neck, or hip pain. Do not let the person drive until a clinician has assessed the episode and advised them.

Ask whether blood pressure lying and standing should be checked, whether an electrocardiogram or blood tests are needed, and whether any medicine or dose could have contributed. Mention fluid intake, recent illness, new symptoms, falls, and every prescribed or non-prescribed medicine. Bring a witness’s account and a list of medicines to the appointment.