Questions.

1. Henry is a 68-year-old man, he has always been fit and active, but attends today because he fell when getting up to turn off his television last night. He feels that he is slowing up quicker than his friends and is concerned about this. Henry takes no alcohol.
   
   What possible causes are you considering at this stage?
   
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   We were considering postural hypotension, possibly related to medicines; a simple trip over loose wires or carpets; or musculoskeletal or neurological problems. Acute illness, visual problems, seizures, cardiac problems do not seem likely at this stage, and cognitive decline though possible seems less probable.

2. Henry takes no prescribed or over-the counter medication; his blood pressure is normal, with no postural drop; pulse rate is regular. However when asked to perform the get-up-and go test Henry understands what he needs to do, but is slow rising from the chair and walking across the room. His time for the test is 35 seconds.What are you thinking now?
   
   What will you do next?
   
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   Henry clearly has a disorder of mobility; he now needs a further musculoskeletal and neurological examination to establish the cause. Henry turned out to have some features very suggestive of Parkinson’s disease, and was referred to a neurologist for further assessment.

3. Molly is 82 years old and lives in a sheltered flat. Her warden has become concerned because she has “almost” fallen a couple of times. Molly has angina, and left ventricular dysfunction and has had some vomiting for which she was prescribed cyclizine 10 days ago, the vomiting has settled but she is still taking the medication.
   
   What do you think precipitated the problem? What will you do?
   
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   Anticholingic drugs such as cyclizine in addition to her other medication may have increased her risk of falling and should be stopped. You might also offer her advice on home safety, and if she wished, and is available in your area suggest some exercise and balance training.

4. Martha is 78 years old, she suffers from osteoarthritis of her hips and knees; diabetes, which is well controlled; hypertension; chronic schizophrenia and has a foot drop. She walks with a stick. Her medication consists of lisinopril, glicazide, metformin, paracetamol, and clozapine. Martha rarely leaves her home because of anxiety, and this has become worse since falling recently.
   
   What might you do?
   
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   Martha should be assessed fully for cardiovascular causes of her fall, including postural hypotension, (which could be related to her medication or a complication of her diabetes), however a combination of factors is probably responsible, and it is probable that she might benefit from multi-disciplinary input. You should therefore consider referring her to a falls clinic