ABSTRACT
A 76-year-old woman was admitted to hospital after being found on the floor by her son. She was able to recall the event: she described standing from her chair and attempting to walk to the next room, when she lost her balance and fell backward. She denied any preceding loss of consciousness, chest pain or palpitations. She did not report sustaining any injuries. She was unable to get back up and so lay on the floor for approximately 1 hour prior to her son arriving and assisting her. There were no features of vertigo or light-headedness. She had been admitted with multiple falls over recent months, all with a similar history of losing balance prior to falling. She had attended the specialist falls clinic a few weeks earlier where she was diagnosed with a high level balance and gait disorder in the context of likely cerebral vascular disease. Her past medical history also included hypertension and hypercholesterolaemia. She took 5 mg ramipril OD and 20 mg simvastatin ON. She lived alone with no formal package of care, but her family visited several times daily. She had required increasing amounts of help at home lately due to difficulty mobilising and progressive cognitive impairment. She mobilised with a frame when supervised but tended not to use this when alone. She was independent with personal care but required help with meal preparation and cleaning. She was incontinent of urine and occasionally of faeces also. She had never smoked. Her son informed the junior doctors that the patient drank around 40–50 units of alcohol per week.
