Table 1 Clinical assessment of patients at risk of falling or who present with history of falling

 History of falling

the number of falls in the past year

The circumstances of falling

History of loss of balance or feeling unsteady when walking

Other medical condition

Document falls history

 Postural hypotension

Assess for risk factors: prolonged recumbency, medication side effects, and extrapyramidal manifestations.

History of light-headedness, weakness, blurred vision, fatigue, headache, or syncope within 1 to several minutes of standing up.

Cardiovascular assessment/consultation should be considered.

Sleeping with the head of the bed elevated may reduce postural hypotension

Preventive measures: e.g., reduce the dosage of blood pressure therapy, wearing compressive calf stocking.

 Medications

Several classes of medications increase fall risk: anti-psychotics, anti-convulsant medications, anti-hypertensives, nonsteroidal anti-inflammatory drugs, muscle relaxants, and diuretics.

More risk is liable with polypharmacy

Choosing the appropriate medications with the least effective on balance and equilibrium is crucial in fall assessment prevention.

 Fall-focused physical examination:

Assessment of the patient’s gait and balance.

Tools for assessment: Timed Up and-Go (TUG), the 30-Second Chair Stand test

• Baseline cognitive assessment

• Neurological examination

• Visual examination.

 Cardiac

• Cardiovascular assessment

• Tilting test

 Assessment of home hazards

Usually carried out by a trained professional, e.g., an occupational therapist.

Hazards that need to be addressed are identified such as loose carpets, seats that are too low or dim lighting, or safety devices that need to be installed such as handrails or grabrails.

 Screen for risk factors

Functional disability

Sarcopenia and frailty