Falls in older adults
In a falls workup, gather and document the circumstances of each fall, loss of consciousness, injuries, the medication list, lying and standing blood pressure, gait, vision and cognition.
Older adults: In these presentations, a collateral history and the medication list matter as much as the examination.
Key takeaways
- Find out whether the patient lost consciousness.
- Review the medication list for medicines that raise falls risk.
- Record gait, vision and cognition alongside the blood pressure.
What this presentation is
A fall in an older adult usually has several contributing causes. The workup looks for each one, since more than one can be addressed.
A collateral history from a relative or caregiver often adds what the patient cannot recall, especially about the moments before the fall.
Gather these sources first
- The referral and any ambulance or emergency department notes
- The current medication list, with recent changes
- Previous geriatric, cardiology or neurology letters
- ECG reports
- Bone density scan reports
- A collateral history from a relative or caregiver
Document these history questions
- Number of falls in the past year
- Circumstances, activity and any warning symptoms
- Loss of consciousness and time spent on the floor
- Injuries, including head injury
- Mobility aids, footwear and the home environment
- Vision, continence and alcohol
- Fear of falling and its effect on activity
Record these findings
- Lying and standing blood pressure
- Pulse rate and rhythm
- Gait and balance, such as a timed up and go test
- Vision and feet
- A cognitive screen
- Injuries found on examination
Ask about these red flags
Record each one as present or absent. Your local pathway decides what happens when one is present.
- Loss of consciousness or syncope
- Head injury, especially on an anticoagulant
- A long time on the floor
- New neurological deficit
- Signs of fracture
- Recurrent falls in a short period
Put these in the assessment draft
- Each contributing factor identified
- Whether the fall was syncopal, mechanical or uncertain
- Medicines that may contribute
- The red flags asked about and the answers
- A plan with referrals, medication review and safety-netting advice
How Workup Desk helps
Add the emergency notes, the medication list and earlier letters to the workspace. Ask which medicines changed in the months before the falls.
Draft the assessment or a handover to the falls service and edit it. Check each answer against the source it names.
Frequently asked questions
Why does loss of consciousness matter so much?
A fall with loss of consciousness may be syncope, which has a different differential and workup from a trip. Record what the patient and any witness remember.
General guidance on what to gather and document, not advice about any individual patient. Local guidelines and your clinical judgment govern.