CASE 87: RECURRENT FALLS
History
An 85-year-old man is admitted to hospital because of a fall in which he has sustained a
mild facial laceration. In the history it becomes evident that he has had around eight falls
over the last 3 months. He says that the falls have occurred in the morning on most occa-
sions but have occasionally occurred in the afternoon. He does not think that he has lost
consciousness although he does remember a sensation of dizziness with the falls. He says
that the falls have not been associated with any chest pain or palpitations. He does not
remember tripping or any other mechanical trigger to the falls. He seems to return to nor-
mal within a few minutes of the fall. On two or three occasions he has hurt his knees on
falling, and on one other occasion he hit his head. He lives alone and there have been no
witnesses of any of the falls.
He smokes five cigarettes a day and does not drink. He has an occasional cough with some
white sputum but he cannot remember whether he was coughing at the time of any of the
falls. He was diagnosed as having hypertension at a routine well man clinic 4 years ago,
and has been on treatment with a diuretic, bendrofluazide and doxazosin, for this. The
blood pressure has been checked in the surgery on three or four occasions and he was told
that it has been well controlled. He was found to have a high fasting blood sugar 6 months
before and had been advised a diabetic diet. There is no relevant family history. He worked
as a messenger until he retired at the age of 70 years.
Examination
He looks well. His pulse is 90/min and irregular. The blood pressure is 134/84 mmHg. The
heart sounds are normal and there is nothing abnormal to find on examination of the respi-
ratory system or gastrointestinal system. There are no significant hypertensive changes in the
fundi. In the nervous system, there is a little loss of sensation to light touch in the toes, but
no other abnormalities.
NormalHaemoglobin 13.8 g/dL 13.7–17.7 g/dL
Mean corpuscular volume (MCV) 86 fL 80–99 fL
White cell count 6.9% 109 /L 3.9–10.6% 109 /L
Platelets 288 % 109 /L 150–440% 109 /L
Sodium 138 mmol/L 135–145 mmol/L
Potassium 4.2 mmol/L 3.5–5.0 mmol/L
Urea 4.6 mmol/L 2.5–6.7 mmol/L
Creatinine 69 &mol/L 70–120&mol/L
Glucose 6.5 mmol/L 4.0–6.0 mmol/L
(fasting)Results of an electrocardiogram are shown in Fig. 87.1.