Why repeated falls in an older person matters
Falls in older people are rarely just bad luck. Several causes usually act together, and each one found is a fall prevented. Dizziness with the falls points to blood pressure, heart rhythm or medicines.
What to ask in the history
- What happened in each fall; the kind of dizziness; standing up
- Any loss of consciousness
- Palpitations
- Medicines: blood pressure tablets, sedatives, diuretics
- Alcohol
- Eyesight, walking aids, the home
- Injuries, and whether he could get up
- Bladder control, mood, memory
Red flags
- Head injury, especially on blood thinners
- Loss of consciousness
- A long time on the floor
- New confusion
What to examine
- Blood pressure lying and standing
- Pulse
- Heart murmurs
- Gait, signs of Parkinsonism, sensation in the feet
- Eyesight, feet
- Memory
- Injuries
First investigations
- ECG, and rhythm monitoring if needed
- Full blood count, electrolytes, kidney function, glucose, vitamin B12, thyroid
- Vitamin D
- Creatine kinase after a long lie
- CT head after a head injury when indicated
- An assessment of bone health
Differential diagnosis of repeated falls in an older person
Grouped, not ranked. Which one fits this patient is for you to work out in the case.
Heart and circulation
- Blood pressure drop on standing
- Arrhythmia
- Aortic stenosis
- Carotid sinus hypersensitivity
Medicines
- Blood pressure tablets
- Sedatives
- Too many medicines
Nerves and muscles
- Parkinsonism
- Neuropathy
- Stroke
- Arthritis
- Weakness
Other
- Poor eyesight
- Hazards at home
- Alcohol
- Anaemia
Common mistakes
- Treating the cut and not the cause.
- Not checking his blood pressure lying and standing.
- Not reviewing his medicines.