History-taking
CPSA · Focused history · Elderly care
Falls / collapse
A “falls” history is really about the cause of the collapse (cardiac, neurological, mechanical) plus the multifactorial risk assessment in the older patient. Get a before/during/after account.
Focused questions
Before
- What were you doing? Warning symptoms (palpitations, chest pain, dizziness, aura)? Standing up (postural)? Provoking factors?
During
- Witnessed? Loss of consciousness? Duration? Colour, jerking, tongue-biting, incontinence (seizure vs syncope)? Injury?
After
- Recovery time, confusion afterwards (post-ictal), residual symptoms
Risk assessment (older patient)
- Medications (antihypertensives, sedatives, polypharmacy), vision, cognition, continence, alcohol, previous falls, home hazards, gait/balance, footwear
Differentials to screen
Cardiac syncope / arrhythmiaSudden, no warning, palpitations/chest pain, quick recovery
Vasovagal syncopeProvoked (standing/pain/emotion), prodrome, quick recovery lying flat
Postural hypotensionOn standing, on antihypertensives, drop in BP
SeizureAura, jerking, tongue-biting, incontinence, prolonged post-ictal confusion
Mechanical fallTrip/environmental, no LOC, clear precipitant
Red flags — exclude these
- Syncope without warning (cardiac — risk of sudden death)
- Exertional syncope (aortic stenosis, HOCM)
- Head injury on anticoagulants
- Recurrent unexplained falls with injury
OSCE tips
- Get a witness account — it’s the most useful part.
- Tongue-biting, incontinence and post-ictal confusion point to a seizure over syncope.
- In older patients do a multifactorial falls risk assessment (meds, vision, gait, home).