The Syncope-Falls Index: a tool for predicting risk of syncope and complex falls in the older adult based on cumulative health deficits

BACKGROUND: Syncope is aetiologically diverse and associated with adverse outcomes; in older people, there is clinical overlap with complex falls presentations (i.e. recurrent, unexplained and/or injurious). AIM: To formulate an index to predict future risk of syncope and falls in the Irish longitudinal study on ageing (TILDA). DESIGN/METHODS: Using the frailty index methodology, we selected, from TILDA Wave 1 (2010), 40 deficits that might increase risk of syncope and falls. This syncope-falls index (SYFI) was applied to TILDA Wave 1 participants aged 65 and over, who were divided into three risk groups (low, intermediate and high) based on SYFI tertiles. Multivariate logistic regression models were used to investigate, controlling for age and sex, how SYFI groups predicted incident syncope, complex falls and simple falls occurring up to Wave 4 of the study (2016). RESULTS: At Wave 1, there were 3499 participants (mean age 73, 53% women). By Wave 4, of the remaining 2907 participants, 185 (6.4%) had reported new syncope, 1077 (37.0%) complex falls and 218 (7.5%) simple falls. The risk of both syncope and complex falls increased along the SYFI groups (high risk group: odds ratio 1.88 [1.26–2.80], P = 0.002 for syncope; 2.22 [1.82–2.72], P < 0.001 for complex falls). No significant relationship was identified between SYFI and simple falls. CONCLUSION: The 6-year incidences of falls and syncope were high in this cohort. SYFI could help identify older adults at risk of syncope and complex falls, and thus facilitate early referral to specialist clinics to improve outcomes.