Falls

Cardiovascular Causes

Orthostatic Hypotension: Drop in blood pressure on standing, often due to dehydration, medications, or autonomic dysfunction.
Arrhythmias: Sudden onset falls with no warning, may be associated with palpitations or syncope.
Aortic Stenosis: Exertional falls, often with associated syncope, dyspnea, or chest pain.
Vasovagal Syncope: Triggered by pain, fear, or prolonged standing; often with prodrome such as dizziness, nausea, or sweating.
Postprandial Hypotension: Drop in blood pressure after meals, common in older adults.

Neurological Causes

Stroke: Acute neurological deficit, often with hemiparesis, dysarthria, or visual disturbances.
Transient Ischemic Attack (TIA): Temporary neurological symptoms, often resolve within 24 hours; risk of subsequent stroke.
Parkinson’s Disease: Shuffling gait, rigidity, and postural instability leading to falls.
Peripheral Neuropathy: Loss of sensation in the feet, leading to unsteadiness and falls.
Seizures: Sudden onset, may be associated with loss of consciousness, tonic-clonic movements, or postictal confusion.
Multiple Sclerosis: Episodes of neurological dysfunction, can affect balance and coordination.
Cerebellar Disorders: Ataxia and poor coordination leading to falls, often with other signs like nystagmus or dysarthria.

Musculoskeletal Causes

Osteoarthritis: Pain and stiffness, particularly in the hips or knees, leading to unsteadiness and falls.
Muscle Weakness: Can result from deconditioning, malnutrition, or specific muscle disorders, leading to falls.
Gait Abnormalities: Abnormal walking patterns due to a variety of causes such as stroke, neuropathy, or musculoskeletal disorders.
Fractures: Falls can be both a cause and a consequence of fractures, especially in osteoporotic patients.
Proprioceptive Dysfunction: Loss of joint position sense, often due to peripheral neuropathy, leading to falls.

Environmental and Psychological Factors

Environmental Hazards: Slippery floors, poor lighting, loose carpets, or uneven surfaces at home.
Alcohol Use: Impaired judgment, coordination, and reflexes increasing the risk of falls.
Medications: Sedatives, antihypertensives, or polypharmacy can contribute to falls through drowsiness, hypotension, or dizziness.
Cognitive Impairment: Dementia or delirium can lead to poor safety awareness and increased risk of falls.
Depression: Associated with psychomotor retardation, fatigue, and poor concentration, increasing fall risk.
Fear of Falling: Can lead to reduced mobility, muscle weakness, and higher fall risk due to lack of confidence in balance.

Onset and Circumstances of the Fall

Timing: Time of day, relation to meals, or specific activities can suggest postural hypotension, postprandial hypotension, or situational syncope.
Activity: What the patient was doing at the time can indicate the cause, such as walking (musculoskeletal), or standing from a sitting position (orthostatic hypotension).
Prodromal Symptoms: Dizziness, palpitations, or nausea before the fall may suggest cardiovascular or neurological causes.
Witnessed or Unwitnessed: Witness accounts can provide valuable information, especially if there were seizure-like activity or syncope.
Injury Sustained: Injuries can provide clues to the fall mechanism, such as head injuries suggesting a sudden collapse.

Associated Symptoms

Palpitations or Chest Pain: May suggest a cardiac cause such as arrhythmias or myocardial infarction.
Headache or Visual Disturbance: Could indicate a neurological cause such as stroke or TIA.
Weakness or Numbness: Localized neurological symptoms can point towards a stroke or TIA.
Joint Pain or Stiffness: Suggestive of musculoskeletal causes such as osteoarthritis or gout.
Dizziness or Vertigo: Indicative of vestibular causes or orthostatic hypotension.
Confusion or Memory Loss: Suggests cognitive impairment, delirium, or postictal state following a seizure.
Incontinence: May suggest a seizure or syncope.

Background

Past Medical History: Chronic conditions such as cardiovascular disease, neurological disorders, diabetes, or previous falls.
Drug History: Specific medications that can cause dizziness, sedation, or hypotension.
Family History: Hereditary conditions such as Parkinson’s disease or cardiomyopathies.
Social History: Living situation, use of walking aids, alcohol use, and home hazards.

Blood Tests

Full Blood Count: To assess for anemia or infection.
Electrolytes: To evaluate for electrolyte imbalances, particularly if dehydration or renal failure is suspected.
Glucose: To check for hypoglycemia in diabetic patients or those with suspected glucose dysregulation.
Thyroid Function Tests: To rule out thyroid disorders contributing to falls, especially in older adults.
B12 and Folate Levels: Deficiencies can contribute to neurological dysfunction and gait instability.
Cardiac Enzymes: If a cardiac cause such as myocardial infarction is suspected.

Imaging

CT/MRI Brain: Indicated if there is suspicion of stroke, TIA, or traumatic brain injury.
X-ray of the Affected Area: To assess for fractures, particularly in the hips, spine, or wrists.
Echocardiogram: Useful if aortic stenosis or other structural heart disease is suspected.
Carotid Doppler Ultrasound: To evaluate for carotid artery stenosis in patients with suspected TIA or stroke.
Holter Monitor: Continuous ECG monitoring to detect intermittent arrhythmias in patients with unexplained falls or syncope.
Bone Density Scan: To assess for osteoporosis in patients with fractures following a fall.

Special Tests

Tilt Table Test: To evaluate for orthostatic hypotension or vasovagal syncope.
Vestibular Function Tests: For patients with dizziness or vertigo, to assess for vestibular causes of falls.
Gait and Balance Assessment: Performed by physiotherapists to identify specific gait abnormalities or balance issues.
Cognitive Assessment: Screening for dementia or delirium in patients with cognitive impairment contributing to falls.
Home Hazard Assessment: To identify and mitigate environmental risk factors contributing to falls.

Medicine of older adult