The prevalence of psychiatric symptoms has hardly been investigated in elderly syncope patients. The aim of this study was to investigate the prevalence of psychiatric symptoms in elderly syncope patients in comparison with elderly patients with falls.

Observational cohort study including consecutive patients aged ≥65 with syncope and/or unexplained falls at an outpatient fall and syncope clinic. Main outcomes were the prevalence of depressive and anxiety symptoms. Secondary outcomes were the prevalence of fear of falling (FOF), 15-item Geriatric Depression Scale, 2-item Patient Health Questionnaire, use of psychotropic medication, and functional activity.

We included 194 syncope patients and 184 fall patients (mean age of 79.7±6.5 [SD] years). Depressive symptoms, including sadness, occurred frequently (33% in syncope group and 23% in fall group, P=0.05). Symptoms of anxiety were present in 20% of both syncope and fall patients. The prevalence of FOF was 68% in the syncope group and 67% in the fall group. Compared with patients without FOF, patients with FOF more often had depressive symptoms (P=0.01), used more antidepressants (P=0.03) and benzodiazepines (P=0.00), and scored worse on the handgrip strength test (19.3±8.4 vs. 22.6±10.2, P=0.01).

Psychiatric symptoms may be common in elderly patients with syncope or falls, occurring in one fifth to one third of these patients. Physicians taking care of older patients with syncope should be aware of the high prevalence of FOF with its associated functional decline, depressive symptoms, and high use of psychotropic medications.