Differential Diagnosis for an Elderly Patient with a Recent History of Falls and Reduced Mobility
The following differential diagnosis is organized into categories to help guide the thought process and ensure that critical conditions are not overlooked.
Single Most Likely Diagnosis
- Osteoarthritis or other degenerative joint diseases: This is a common condition in the elderly population that can cause pain, stiffness, and reduced mobility, increasing the risk of falls.
- Chronic musculoskeletal pain: Pain from various musculoskeletal conditions can significantly impair mobility and increase the risk of falls due to decreased strength, balance, and gait speed.
Other Likely Diagnoses
- Neurological conditions (e.g., Parkinson's disease, stroke): These conditions can affect balance, gait, and overall mobility, leading to an increased risk of falls.
- Cardiovascular diseases (e.g., orthostatic hypotension): Conditions that affect blood pressure regulation can lead to dizziness and fainting, increasing the risk of falls.
- Sensory impairments (e.g., vision or hearing loss): Impairments in vision or hearing can affect balance and spatial awareness, contributing to falls.
- Medication side effects: Many medications commonly used in the elderly population can have side effects such as dizziness, orthostatic hypotension, or confusion, which can increase the risk of falls.
- Vitamin D deficiency or osteoporosis: These conditions can weaken bones and muscles, making falls more likely and potentially more severe.
Do Not Miss Diagnoses
- Infections (e.g., urinary tract infections, pneumonia): Infections can present atypically in the elderly and may cause confusion, weakness, or dizziness, leading to falls.
- Acute abdominal conditions (e.g., appendicitis, intestinal obstruction): These conditions require prompt medical attention and can cause severe pain, leading to falls.
- Cardiac conditions (e.g., myocardial infarction, arrhythmias): Certain cardiac conditions can cause chest pain, shortness of breath, or palpitations, leading to falls.
- Subdural hematoma or other intracranial hemorrhages: Falls can be both a cause and a consequence of these conditions, making prompt diagnosis critical.
- Spinal cord compression or cauda equina syndrome: These are medical emergencies that can cause severe back pain, weakness, and loss of bladder or bowel control, leading to falls.
Rare Diagnoses
- Multiple system atrophy: A rare neurodegenerative disorder that can cause parkinsonism, autonomic dysfunction, and cerebellar ataxia, leading to falls.
- Normal pressure hydrocephalus: A condition characterized by the accumulation of cerebrospinal fluid in the brain, leading to gait disturbances, dementia, and urinary incontinence.
- ** Tabses dorsalis (neurosyphilis)**: A rare condition that can cause loss of proprioception, leading to gait disturbances and increased risk of falls.