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The question

I'm a 68-year-old male and I've collapsed twice, one time putting a big dent in my living room wall. Many times my thighs feel weak and I have a mild sense of vertigo while out shopping. A catscan confirms I do not have a brain tumour. Senior friends of mine have also collapsed at one time or another: some needing assistance to get up, and others needing stitches because of the fall.

What's the cause of all these senior collapses?

The answer

Syncopal episodes, or falling with a temporary loss of consciousness is a significant issue that can have potentially severe complications. Generally this is caused by a temporary decrease of the brain's supply of blood which can be due to a change in blood pressure, lack of food or more serious causes such as heart or neurologic disease.

People of any age can faint, but older people more often have a serious underlying cause. The impact of collapsing can be significant both physically and emotionally. Falling accounts for approximately one half of deaths due to injury in the elderly, so I cannot overemphasize the importance of early investigation to potentially understand what may be the cause and work to put in place preventative strategies.

As we age, physical instability increases due to muscle weakening, arthritis, slowed reflexes, increased instability of blood pressure, and decreased vision. But falling is not a normal part of aging - you're smart to be concerned.

In order to understand what may be causing these collapses in you and your friends - a thorough medical history investigation and physical examination is warranted. A CT scan is usually done to rule out stroke, injury or tumour suspected and while it is reassuring that your CT scan was normal, further investigations may be considered to understand why this has occurred twice.

Your doctor will want to know what you were doing prior to the episodes: were there any other associated symptoms prior to the episode? What medications are you taking at the time?

Potential causes of syncope can be divided into individual causes and environmental causes:

Individual causes:

Cardiovascular conditions: Blood pressure fluctuations, arrhythmias (abnormal heart rhythms such as atrial fibrillation or rapid or slow heart beat) or abnormal heart structure such as valve dysfunction can all cause syncope. Your doctor may ask if you have other symptoms such as chest pain, palpitations (sensation of irregular heart beat) or shortness of breath preceding the collapse which may increase suspicion of a cardiovascular cause.

Neurologic conditions: While rare, it is important to discuss neurologic causes of syncope. The main one to consider is something called transient ischemic attack (TIA) where there may be decreased blood flow to the brain due to a blockage of blood flow through one of the main arteries to the brain. This may be accompanied by double vision, slurred speech and loss of balance. While seizure disorders are a concern, they generally have other accompanying symptoms such as post-collapse fatigue, incontinence and characteristic movements.

Medications: As we age, the number of medications we take increases, which in turn increases our experiences with side effects. A review of medications with your doctor or pharmacist may help identify some of these potential interactions.

Change in balance/walking: Musculoskeletal conditions such as arthritis and osteoporosis can affect balance and gait.

Postprandial fainting: Can occur in elderly people when blood pressure drops about an hour after eating.

Postural syncope: A change in position - usually from lying down or sitting to standing - can cause a decrease in blood flow to brain secondary to a blood pressure drop leading to dizziness, weakness in the legs and can potentially cause collapse.

General conditions: Hypoglycemia (low blood sugar), dehydration, or infections such as pneumonia can cause weakness and increases the risk of collapse.

Environmental causes: Collapses may be due to environmental factors such as loose rugs, stairs and poor lighting.

Falls can be a warning sign of something more serious, and if they recur can lead to serious negative outcomes. Once you work through a potential list of causes with your doctor by having the appropriate investigations, you may be able to prevent further falls from occurring

Send family doctor Sheila Wijayasinghe your questions at She will answer select questions, which could appear in The Globe and Mail and/or on The Globe and Mail web site. Your name will not be published if your question is chosen.

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