Syncope is a common and particularly troublesome problem in the elderly population. In a series of 146 patients admitted for syncope to an acute care hospital in Chile during a 4-year period, 2/3 (68%) were aged 65 years and older. A specific etiology could be established in 62%, and 3/4 of these were cardiovascular in origin. Diagnosis was established entirely on history, physical examination, resting ECG, and 24-hour cardiac monitoring in most cases but in some, more sophisticated measures (i.e., echocardiography, electrophysiologic studies, blood tests, EEG) were needed, and mostly to confirm clinically suspected problems. In-hospital mortality was 2.1% and mortality at the end of the approximately 2-year follow-up period was 18.1%. Mortality was higher for persons over age 65 than for younger persons (23.9% vs 2.3%), and for persons with cardiovascular syncope than for persons with other kinds of syncope (28.3% vs 8.9%). This study confirms the particular lethality of syncope in the elderly population and outlines a relatively simple strategy with which most syncope patients can be diagnosed without resorting to expensive procedures.