o Age-related decline in muscle mass and strength
o Leads to impaired balance, slow reflexes
o Cataract: reduced acuity, glare sensitivity
o Macular degeneration: central vision loss → difficulties with depth perception
o Glaucoma: peripheral visual field loss
o Common in diabetes, B12 deficiency, alcohol use
o Reduced proprioception → unsteady gait
o Festinant gait (short, shuffling steps), reduced arm swing
o Freezing episodes at turns or narrow spaces
o Postural instability
o Wide-based, unsteady gait
o Associated with dysarthria, intention tremor, nystagmus
• Medications
o Sedatives (e.g., benzodiazepines, z-drugs)
o Antihypertensives (e.g., alpha-blockers, diuretics → orthostatic hypotension)
o Polypharmacy increases cumulative risk
• Environmental hazards
o Poor lighting, loose rugs, clutter
o Uneven flooring, lack of handrails
o Stand from chair, walk 3 metres, turn, return, and sit
o 12 seconds suggests increased risk of falls
o Significant if ≥20 mmHg systolic or ≥10 mmHg diastolic drop within 3 minutes of standing
o Symptoms: dizziness, lightheadedness
o <0.8 m/s (measured over ~4 m) → marker of frailty and predictor of morbidity
o Balance tests (e.g., tandem stance, single-leg stand)
o Romberg test (sensory ataxia)
• Footwear
o Loose or poorly fitting shoes → trip hazard
o Check for non-slip soles
• Foot deformities
o Bunions, hammertoes, ulcerations
• Cognitive screen
o Delirium, dementia → impaired judgement, misinterpretation of environment
o Strength and balance training (e.g., physiotherapy programmes)
o Medication review and deprescribing
o Home hazard assessment and modifications
o Vision correction
o Consider if deficient; some evidence suggests reduced falls risk
o Walking aids, grab rails
o Alarm systems, fall detectors for high-risk individuals
Extra Revision Pearls
• Fear of falling → can lead to activity restriction → further deconditioning → "frailty spiral"
• Hip protectors: controversial but may reduce fracture risk in institutionalised older adults
• Recurrent falls: defined as ≥2 falls in 12 months → triggers comprehensive geriatric assessment
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Author & Educational Disclaimer
Author:
Dr Phillip Cockrell BM FRCP DipClinEd
Dr Phillip Cockrell is a UK Consultant Physician in Internal Medicine, currently working at Queen Alexandra Hospital, Portsmouth University Hospitals NHS Trust. He has previously worked as a registrar across Intensive Care Medicine, Gastroenterology, Cardiology, Stroke Medicine, Acute Medicine, and Respiratory Medicine.
He has held senior leadership roles including Associate Clinical Director of the Acute Medical Unit, Clinical Director of Internal Medicine, and Chief of Medicine. Dr Cockrell has over 15 years’ experience in postgraduate medical education, having lectured extensively across the MRCP syllabus and contributed to MRCP revision teaching and course development.
Dr Cockrell holds a Bachelor of Medicine (BM), Fellowship of the Royal College of Physicians (FRCP), and a Diploma in Clinical Education (DipClinEd). His teaching approach is based on structured consolidation of complex medical topics to support efficient and effective revision for postgraduate examinations.
Purpose of this content:
The material on this page is intended solely for educational purposes to support revision for the MRCP (UK) Part 1 examination. It reflects examination-relevant principles of internal medicine and is designed to aid learning and pattern recognition.
Medical disclaimer:
This content is designed for postgraduate medical examination revision and does not constitute medical advice, diagnosis, or treatment guidance and must not be used as a substitute for professional clinical judgement, local guidelines, or specialist consultation. Clinical decisions should always be made in the context of individual patient circumstances and current national guidance.
