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she is in pretty good health for 91. I never know when she is going to have one so I am afraid to leave her alone. It happens so quick and then afterwards she seems fine.

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Fainting is a sign of dementia...my mom had lewy body dementia she fainted quite often. She passed away this week and she was also 91. If she starts talking strange or saying things that seem a little off. I encourage you to have her checked. Good luck
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Fainting can be a sign of heart problems especially at that age. It is very much worth getting her in to medical attention ASAP and at least having an exam and and echocardiogram done. If she is having some cognitive problems as well as fainting, and there is an underlying heart arrhthymia, treating it could prove very helpful!
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It could be poor circulation or potassium, dehydration.
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Low blood pressure.
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“Fainting”, also known as syncope, is an abrupt, temporary loss of consciousness w/ loss of postural tone (i.e. slumping/falling downward) that is followed by an immediate recovery (within a few minutes) which is caused by a temporary sharp decrease in blood flow to the brain. It is important to distinguish syncope from other causes of loss of consciousness where recovery is not immediate (e.g. shock or cardiac arrest, coma, stroke, seizures), or where convulsions may occur (i.e. seizures), or where loss of consciousness was preceded by head trauma (e.g. concussion). You may find these distinctions are not always properly made when syncope is discussed (even on medical websites), but making these distinctions helps better understand the disorder and keeps everyone on the same page.

There are several major reasons for syncope. One of the more common reasons is vasovagal (also called neurocardiogenic) syncope which involves a complex neurovascular reflex response that lower blood pressure and decreases heart rate to cause decreased blood flow to the brain which results in fainting. There are a wide variety of commonplace triggers for vasovagal syncope, including prolonged standing, heat exhaustion, fatigue, swallowing, coughing/sneezing, sudden stress/fear, urinating, laughing, etc. This kind of syncope is benign and can be diagnosed by clinical history and, if needed, by a procedure called tilt-table testing.
Another potential cause of syncope is orthostatic-related, in which standing up results in a drop in blood pressure (usually with an increase in heart rate). This can be cause by volume-depleted states (e.g. prolonged vomiting/diarrhea, poor oral intake, substantial acute blood loss), blood pressure medications, or dysfunction of the autonomic nervous system (which controls blood pressure/heart rate) that can occur in disorders like diabetes, spinal cord injuries, parkinson’s disease, and others.

Then there are cardiac causes for syncope that can include arrhythmias (irregular heart rhythms), structural problems (aortic valve disease, cardiac masses), hypertrophic cardiomyopathy, tamponade, or any other cardiac conditions that cause decreased blood outflow from the heart to the point of transient poor blood flow to the brain, resulting in fainting. Again, this is distinguished from cardiac situations that result in prolonged blood flow stoppage (cardiac arrest) or prolonged severe decrease in blood flow (cardiac shock), where one would pass out but not wake back up in a few minutes.

Finally, there is cerebrovascular syncope where there is a transient drop in blood flow to the brain caused by problems at the level of the blood vessels flowing to the brain. Transient ischemic attack (TIA, also known to non-medical people as “mini-strokes”) can less commonly present as syncope, but usually TIA has some neurologic deficits (like paralysis, vision loss, sudden numbness/tingling, confusion, trouble speaking, etc) instead. A vascular steal syndrome (where blood flow to the arm is blocked causing shunting of blood flow away from the brain during arm exercise) is another rare cause of cerebrovascular syncope. Cerebrovascular syncope is to be distinguished from a true stroke where loss of consciousness, if it occurred, would be prolonged.

It is important to talk to one’s doctor about syncope sooner rather than later to find out what’s going on and to make sure there is not some dangerous underlying cardiac or neurological disease. Even if it is caused by a benign condition, syncope by itself, particularly in the elderly, can result in a traumatic injury like head trauma or hip fractures just by virtue of falling down, and that can cause a lot of problems. If syncope is occurring frequently, it would be also important to have fall safety precautions instituted in the place where the elder is living to help prevent injuries.

Hope this helps answer your question. If you have further questions about this topic, feel free to contact me directly (see my profile for details).

Best wishes
Vik Rajan, M.D.

DISCLAIMER
The information provided above is FOR EDUCATIONAL USE ONLY, and DOES NOT CONSTITUTE MEDICAL ADVICE/OPINION, is not meant to diagnose or treat any illness or disease, and is not a substitute for the medical evaluation and advice of your (or your loved one’s) primary care physician or other medical professional. While striving to be factual and exact, no warranties are made with regards to the accuracy of the information provided above. You are always advised to talk with your (or your loved one’s) doctor about any health concerns that you have and about any of the information provided above. Sole reliance on the information provided above is not advised and would be solely at your own risk and liability.
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My mom has had two syncope episodes in the past year. One resulted in a visit to urgent care. They did an EKG and wanted her admitted to the ER right away. Sadly, she refused treatment. It stinks living this way. I hope your mom is open to treatment for this condition.

I would rather be in the know than living in limbo land.
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Dr. Vic gave an excellent and comprehensive answer above, and the upshot is: Get this looked at medically!! It may be treatable and it may be urgent.
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Agree vstefans, Dr. Vic's advice was very interesting and informative to me. The hard part is actually getting your parent to the ER. Mine signed off on it. Takes her DNR very seriously, but doesn't give me much of a level of comfort. Blah! I live in fear of that middle of the night phone call, well not so much as I've reconciled that's her choice. It will still be horrible when it actually happens.
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My mother has late stage alzheimer disease since January, no walking, talks a bit, has to be fed, she was diagnosed 3 yrs ago, since February, she has passed out or fainted, at first every other month, now every 2 to 3 weeks. She comes out of it after a few minutes, seems a bit weak, scary, them back to where she was before fainting. Is this a symptom seen at end stage ?
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TJ, when did these fainting episodes happen? My sig other use to feel very faint any time he got up from a sitting or lying down position. Well, it turned out for him to be an easy fix... the doctor had him take lower dosage of blood pressure medicine. Hadn't had an issue since.

Take your Mom to her primary doctor to see what is the cause. There could be a dozen of reasons why this is happening, from being dehydrated to not enough blood circulating.
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TJ, this is an old thread, and she may be having cardiac spells of some sort - this is not just part and parcel of Alzheimer. You can decide to investigate and treat it or not (if it is cardiac, could need a pacemaker.) Maybe start a new discussion or question here if you need input on that as a difficult decision?
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