The walker just in case — fear of falling, deconditioning

Fear of falling is not the absence of a diagnosis — it is a mechanism: Vellas showed fallers restrict their mobility, Zijlstra’s prevalence work showed the avoidance is common among community-living older people, and the consequence — deconditioning — manufactures the risk the fear was avoiding. Her examination says the loop has outgrown the deficit: a cautious TUG, global disuse weakness, a high FES-I, and nothing neurological. The treatment breaks the loop where it turns, with graded re-exposure to the avoided activities, deliberately built self-efficacy and a group exercise programme, and it re-measures the fear on the scale Yardley validated. What you do with it: name the loop to her, climb the exposure ladder from the front step to the park loop, put the training in a group, check the home hazards, and retire the indoor walker as the strength and the confidence return — because the alternative is prescribing the disease.

• New dizziness, syncope or a change in the gait pattern — the deconditioning story does not cover new signs; reassess the mechanism
• Mood symptoms escalating with the isolation — the avoidance is costing more than fitness; involve the GP early

• Three falls in six months — the multi-factorial work-upTier 4
• The grocery-store dizziness — PPPDTier 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.