Falls in elderly

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍hourday history of falls

Occurred ‍ times, ‍ ‍at homeoutdoors

Event surrouding the fall: ‍ ‍tripslipleg giving outlose footingcollapsefaintdizzinessloss of balance

Preceded by ‍no other symptomsdizziness,



Injury sustained: ‍none, ‍head injury, ‍neck injury, ‍fractures, ‍bruises, ‍cuts

Level of consciousness after the fall: ‍normalaltered

Assistance required to get up: ‍yesno

Fall witnessed by someone: ‍yesno



Associated symptoms: *Try using right-click for negatives*

‍loss of consciousness

‍altered conscious state

‍dizziness

‍confusion

‍palpitations

‍chest painf

‍shortness of breath

‍visual disturbances

‍difficulty walking

‍leg weakness

‍numbness or tingling



Contributing factors:

‍home environment hazards (loose carpets, poor lighting)

‍not using glasses consistently

‍not using hearing aids consistently

‍sedentary lifestyle

no history of: ‍previous falls, ‍osteoporosis, ‍eye disease, ‍heart disease, ‍stroke, ‍Parkinson's disease, ‍osteoarthritis, ‍dementia, ‍diabetes

no use of: ‍antidepressants, ‍anticholinergics, ‍anti-hypertensives, ‍diuretics, ‍antipsychotics, ‍sedatives, ‍opioids





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Head: ‍normocephalicatraumatic, scalp ‍normalrashlesion

Eyes: conjunctiva/sclera ‍normal, lids/lashes ‍normal, cornea ‍intact, ‍PERRL, extraocular movements ‍intact, OD 20/‍, OS 20/‍

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Abdomen: ‍soft, ‍non-tender ‍, ‍non-distended, ‍guarding, bowel sounds ‍normal, ‍, ‍CVA tenderness ‍

Skin: ‍rashlesions on ‍

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍

Musculoskeletal: joints ‍ ‍normal, ‍limited ROM

Cervical spine: ‍tenderness on ‍, range of motion ‍fulllimited

Shoulder: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Elbow: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Wrist: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Hand: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Lumbar spine: ‍tenderness on ‍, range of motion ‍fulllimited

Hip: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Knee: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Ankle: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Foot: ‍rightleft: ‍tenderness on ‍, range of motion ‍fulllimited

Neurologic: cranial nerves ‍intact, strength ‍intact 5/5, sensation ‍intact, reflexes ‍intact 2+, cerebellar function ‍intact, gait ‍steady

Mental status: ‍alert, ‍oriented, speech ‍clear, mood ‍normal, thought ‍organized, ‍suicidal ideation, judgment ‍good





ASSESSMENT:

‍Recurrent falls ‍likelysuspectedpossible

DDx: accidentals fall due to environmental factors, syncope, muscle weakness, balance disorder, vestibular dysfunction, neurological condition, medication side effect (e.g., sedatives, antihypertensives), orthostatic hypotension, cardiac event (e.g., arrhythmia, myocardial infarction), vision impairment, cognitive impairment, gait abnormality, footwear or walking aid issues, home hazards, alcohol intoxication, dehydration, electrolyte imbalance, seizure, osteoarthritis, infection leading to weakness, peripheral neuropathy, cerebrovascular accident (stroke), transient ischemic attack (TIA), delirium

Trauma from the fall: ‍, ‍none, ‍head injury, ‍neck injury, ‍fractures, ‍bruises, ‍cuts





PLAN:

Investigations:

- Blood work: ‍CBC, ‍electrolytes, ‍creatinine, ‍glucose, ‍TSH, ‍vitamin B12, ‍calcium, ‍albumin, ‍coagulation profile

- Urinalysis

- ECG

- Chest X-ray

- Orthostatic blood pressure measurements

- Bone density test

- Vision test

Treatments:

- Physical therapy

- Occupational therapy

- Home safety evaluation

- Reassess medications that may contribute to falls (antidepressants, anticholinergics, anti-hypertensives, diuretics, antipsychotics, sedatives, opioids)

- ‍Walking aids

- ‍Vitamin D supplements

- ‍Calcium supplements

- ‍Bisphosphonates

Further care:

- Referral to fall prevention program

- Referral to geriatrician

- Follow-up in ‍ ‍weeksmonths

- Return if falls continue or if new symptoms develop such as dizziness, weakness, or confusion