A multidisciplinary care pathway based on current guidelines was developed to evaluate unexplained non-accidental falls and/or syncope in geriatric patients aged 65 years or older.

We applied the lean six-sigma methodology. In the assessment phase, we defined the historic level of care for syncope patients in a small sample of patients. In the improvement phase, we developed a new clinical pathway with a close collaboration between geriatricians, cardiologists and neurologists. This 2 day structured diagnostic program included a comprehensive geriatric assessment, evaluation of nutritional status and disabilities, laboratory tests, and 12-lead electrocardiogram. In case of fall problems, brain-MRI or CT scans were performed. Blood pressure measurements for orthostatic and postprandial hypotension were performed. When indicated, patients were seen by a neurologist, cardiologist, dietician or old age psychiatrist. During the sustain phase, we implemented our new program and critically evaluated 262 patients.

Of the 262 patients, aged 79.6±6.5 years, only 44 patients were referred for evaluation of syncope while in 117 patients, a syncope was diagnosed. Sixty-one patients were diagnosed with both a syncope and separate falls. Only 6 of the 117 elderly patients had syncope without falling.

With this novel multidisciplinary pathway for the combined evaluation of unexplained non-accidental falls and syncope, we achieved a diagnosis in 89% with a large overlap between falls and syncope. Therefore, cardiologists, neurologists and geriatricians should collaborate for the evaluation of falls and syncope.