Does Anyone Have a Fainting Couch? What seniors should know about fainting

Adults 50 and older now are being told to know what fainting all is about. A little new knowledge may save lives. You may have heard that people who feel faint should sit with their heads between their knees, but is that true? How can you tell whether you or someone else who has fainted should go to the emergency department or perhaps even see a cardiologist?

Dr. Elijah Behr is with the Mayo Clinic and he said there are several things to know about fainting. Blacking out or fainting is called syncope. It is a temporary loss of consciousness due to insufficient blood flow to the brain. There are different types of syncope. Dr. Behr said vasovagal syncope is the medical term for the most benign kind of fainting, simple fainting without a serious underlying cause. This type of fainting is common.

"In some people, if they have a drop in blood pressure from emotional distress, pain, illness or dehydration, for example, or just generally have a low blood pressure, any provocation causes a reflex in the heart," said Dr. Behr. "Rather than the heart speeding up and pumping more forcefully to maintain the blood pressure, it starts to slow down. The blood pressure drops, the heart rate slows further, and the heart can pause for many seconds and sometimes close to a minute for some people who have more severe fainting episodes."

Usually with this type of fainting, the person falls to the floor, blood pressure returns to the brain and the person starts to recover. However, if someone faints in a vulnerable location or vulnerable position, it can be dangerous to that person and others, said Dr. Behr.

The syncope that most concerns healthcare professionals is cardiac syncope, blacking out due to an underlying heart disease such as a heart rhythm abnormality or arrhythmia.

"This is usually a more abrupt loss and return of consciousness than in simple fainting. If you're older, you're more likely to have underlying heart disease that you may or may not be aware of. “That's one of the reasons to be more concerned about loss of consciousness in older individuals. Young people can also have heart diseases that can cause cardiac syncope that may be a warning sign of something more serious to come, so it is important to investigate it," said Dr. Behr

Before a person faints, they might experience one or more signs that they should sit or lie down. "There will be a sensation of lightheadedness. There may be a sensation of nausea or buzzing or ringing in the ears," said Dr. Behr. "Some people describe tunnel vision and their vision closing in on them before they actually pass out. Some may actually lose vision but still be aware, not lose consciousness completely, and then recover. Other typical signs include feeling sweaty and clammy."

Please Get my Smelling Salts

Smelling salts release ammonia that irritates the passages of the nose and airways causing a person to respond and breathe more rapidly and deeply. It is not really a suitable treatment for fainting as this relates to low blood pressure. It may help to rouse a patient more quickly, if they are drowsy for other reasons.

Some people get about a half-hour of warnings before fainting. Some people may get 30 seconds. So, what should you do when someone faints? First, check that the person is breathing and has a pulse. If not, call for emergency help. If you know how to perform CPR, initiate it. If the person is still breathing and has a pulse, ensure they are lying flat, and their airway is open using the recovery position and call for help.

If you are 50 and older and you feel like a fainting spell coming on, position your head lower than your heart.  For example, between the knees. Rest after coming out of the faint. Drink water after the faint, adding electrolytes if you have them. "If your blood pressure is getting low and you're getting those symptoms, it means the blood doesn't get into your brain, and if your heart is trying to push the blood to your brain against gravity, then it's struggling. You really need to get your head level or below your heart so the blood pressure gets back to the brain, and that will avert all the symptoms and the vicious cycle that ensues," said Dr. Behr. 

It is important to put your head between your knees or lie down and put your head down and your feet up in the air if it is feasible. Getting up and walking around straight away is not recommended. "Your blood pressure will drop further, and you’ll feel worse, and collapse and fall and injure yourself," said Dr. Behr. "The best thing is to stay where you are and get flat, and when you're feeling better, drink some water, maybe with some electrolytes if you're dehydrated. For general preventive measures, we advise most people who have fainted to drink more water and to sometimes add a bit of salt to their food, because generally they're running a low blood pressure.”

In general, simple fainting is more common in women and age matters. “Women tend to run lower blood pressures than men and therefore the triggers for fainting that include dehydration, and emotional triggers are more likely to cause a faint. When it presents for the first time in older patients it has less of a predilection for being female and there are always other possible causes of blackouts that may have greater risk associated with them and need to be tested for,” said Dr. Behr.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com