Evaluation of Recurrent Falls Core Concept: Maintaining an upright posture requires the integrated function of multiple systems. Disruption in any of the following areas can contribute to falls. 1. Oxygenation of the Brain Category: Cardiopulmonary Disorders • Examples: - Orthostatic hypotension - Cardiac arrhythmias (e.g., atrial fibrillation with rapid ventricular response) - Heart failure - Syncope (vasovagal, cardiogenic) - Pulmonary embolism - Severe anemia • Clues: Syncope or presyncope, exertional symptoms, hypotension 2. Sensory Input Category A: Visual Disorders • Examples: - Cataracts - Macular degeneration - Glaucoma - Retinopathy • Clues: Bumping into objects, recent vision changes Category B: Auditory/Vestibular System • Examples: - Benign paroxysmal positional vertigo (BPPV) - Meniere’s disease - Vestibular neuritis • Clues: Vertigo, imbalance when turning head Category C: Proprioceptive Impairment • Examples: - Peripheral neuropathy (e.g., diabetic, B12 deficiency) - Spinal cord disorders • Clues: Numbness in feet, positive Romberg sign 3. Motor Strength Category: Neuromuscular Disorders • Examples: - Stroke - Parkinson’s disease - Myopathies - Motor neuron disease (ALS) • Clues: Focal weakness, muscle wasting, slow movements 4. Joint Movement Category: Musculoskeletal Disorders • Examples: - Osteoarthritis - Rheumatoid arthritis - Joint instability (e.g., post-injury) • Clues: Joint pain, limited range of motion, gait abnormalities 5. Coordination of Movement Category A: Cerebral Cortex • Examples: - Dementia - Stroke - Seizure disorders • Clues: Cognitive decline, neglect, postictal confusion Category B: Basal Ganglia • Examples: - Parkinson’s disease - Huntington’s disease • Clues: Bradykinesia, rigidity, tremor Category C: Cerebellum • Examples: - Cerebellar stroke - Alcohol-related cerebellar degeneration - Multiple sclerosis • Clues: Ataxia, dysmetria, intention tremor 6. Additional Contributing Factors • Medications: Sedatives, antihypertensives, polypharmacy • Environmental Hazards: Poor lighting, slippery surfaces • Psychiatric: Depression, fear of falling, functional gait disorders #Recurrent #Falls #Diagnosis #Differential #Evaluation #Geriatrics #Neurology
