Three falls in six months — the multi-factorial work-up

The recurrent geriatric faller is the presentation the multi-factorial model was built for: the STEADI algorithm, the NICE falls guideline and the World Falls Guidelines all begin with a structured assessment across medication, orthostatic blood pressure, home hazards and balance — because the cause is almost never singular, and here it is plainly a sedative at night, a probable orthostatic drop, a hazardous landing and a slowing gait. The treatment is equally plural: Campbell’s trial showed psychotropic withdrawal prevents falls, the Beers Criteria flag the zolpidem, the Cochrane review supports home-hazard modification done properly, and progressive balance and strength training is the strand no guideline drops. What you do with it: run the full work-up including lying-and-standing blood pressure at one and three minutes, write to the prescriber about the zolpidem, send the home-safety visit, start the training, and arrange the check-in — as one plan with one owner, not four referrals into the void.

• A fall with head strike, loss of consciousness or new neurological signs — medical review before the next session
• A measured orthostatic drop with symptoms — back to the prescriber; the amlodipine and tamsulosin join the zolpidem in the review
• Syncope in the story — cardiac work-up first, balance programme second

• The walker just in case — fear of falling, deconditioningTier 1
• Can’t feel the floor — neuropathy, foam and the RombergTier 2

This page carries the case’s first decision. The full sequence — every decision, the examination by domain, and the debrief that grades you — is in the drill, and the library is included with membership.