Assessment of the Geriatric Patient: Gait and Balance

Mark E. Williams, MD; Angela Gentili, MD

Disclosures

November 16, 2009

In This Article

Office Evaluation of the Patient Who Has Experienced a Recent Fall

Key features in the history:

Evaluating the elderly person who has experienced a fall is a key aspect of geriatric assessment. Historical points include medications taken, history of previous falls, and the circumstances of the fall. Important considerations include the location, time of day, presence of witnesses and their account of the fall, and the relation of the fall to cough, position, urination, or head turning. Another useful inquiry is the patient's thoughts on the cause.

Specific questions to consider:

Did the patient have any awareness of falling or was it totally unexpected? Did the patient slip or trip? Was there any loss of consciousness? Did the patient have immediate recall after the fall? Could the patient get up and walk? Was there any incontinence of urine or stool? Can a witness verify any loss of consciousness? Were there associated symptoms such as dizziness or vertigo, palpitations, chest pain, dyspnea, aura, or a sudden focal neurologic event?

Key physical findings:

Key aspects of the physical exam include level of consciousness, mental function, vital signs, skin findings, cardiovascular abnormalities, examination of the extremities, and a careful neurologic exam. Functional testing should include toe tapping, functional reach, and Tinetti's modified "up and go" test.

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