Conclusion/Summary
One of the greatest achievements of public health in the twentieth century has been the almost doubling of life expectancy in the Western world. Healthcare professionals are increasingly treating more old and very old patients. The prevalence of syncope rises with age and is challenging because of atypical presentation, overlap with falls and poor recall of events. Elders are less likely to have a prodrome, may have amnesia for loss of consciousness and unwitnessed events. Cardiac causes and dual pathology are more common and compliance with newer monitoring technologies is inadequate. Consequent morbidity and mortality is higher than in younger patients. A high index of suspicion for cardiovascular causes of falls and dual pathology will increase diagnosis and early targeted intervention.