Question

an 82-year-old woman has been admitted to the emergency department three times in the past 6 months for a fall without a major injury. what are some possible causes of these frequent falls? what essential assessments would you perform? what referrals would you make and why?

Answer 1

Here the patient is 82 year old woman so she comes under old age group. The etiogical factors for falls are dementia which causes impairment,visual impairment, osteoarthritis , muscle weakness. These are common in old age due to physiological changes. Parkinson's disease which causes rigidity, bradykinesia, orthostasis and cognitive impairment. Dizziness due to hypotension is also leads to falls. Hypotension common in aging due to age related change leads renin angiotensin system impairment. Alteration in balance causes falls. Psychotropic drugs, cardiac drug and hypoglycemic agents also leads to falls.

Assessment

History : Information about falls.

Medication history

Physical examination :

• Vital sign including orthostatic blood pressure.
• Gait and balance evaluation
• Neurological examination
• Function evaluation
• Cognitive assessment
• Cardiac and musculoskeletal examination

Diagnostic evaluation

Screen for the following :

• Cataract
• Syncope
• Stroke
• Hypotension
• Parkinson's disease
• Dementia
• Cognitive impairment