# An 85-year-old who keeps falling: a falls case to work up

> A geriatric medicine case for medical students: an 85-year-old who lives alone and has fallen about eight times in three months, dizzy each time. What to ask, examination, first tests and the causes.

- Geriatric Medicine · Intermediate · about 20 minutes
- Web page: https://www.medikarya.in/case-studies/85-year-old-man-who-keeps-falling
- Work up this patient: https://www.medikarya.in/case-studies/85-year-old-man-who-keeps-falling

## How the patient presents

An 85-year-old man who lives alone has fallen again and cut his face. He has had about eight falls in the last 3 months and is dizzy each time.

## 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.

---

A study guide for medical students, not medical advice. Follow your institution's protocols in practice.