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Unsteady balance / Falls

Scenario: Max, 41 years old, has been in supported care for most of his life. He is popular with the staff, and easy-going, though quite slow on the uptake. Lately, staff have been concerned about Max. He has become unsteady on his feet. He has had an increasing number of small falls, without hurting himself, but yesterday had a nasty one. This occurred at the local bowl. Max couldn't release the bowling ball, and ended up going down the lane with it! Possible causes of Max's unsteady gait include both general causes and local causes.

General causes include:

• Blood pressure problems. 'Postural hypotension' is the fall in blood pressure produced by standing up. It is also a side effect of certain medications. Dizziness, fainting, and unsteadiness are the symptoms. Blood pressure medications and psychiatric medications are amongst the causes of this problem.
• Medications: too high an intake. Certain anti-epileptic tablets such as Dilantin® or Tegretol® may cause unsteadiness if the dosage is excessive. An excessive dose of antidiabetic tablets or insulin may also cause unsteadiness.
• Medications: too low an intake. This mainly occurs because medications are not taken.
• Drug or alcohol abuse. This is the most likely cause in younger people, but probably not the kind of thing that Max would be up to, given the sort of person he is.
• Diabetes of recent onset.
• Infection in some part of the body, such as the lungs (bronchitis or pneumonia).
• Anaemia (a low blood count).

More specific causes include:

The brain controls the smoothness and steadiness of limb and body movements. Problems in this area may lead to an unsteady gait and/or jerky movements. In Max's case the problem may have been caused by:

• A head injury causing clot formation and pressure on the brain. If this is suspected urgent assessment is required.
• A mild form of stroke.
• Other problems in the brain.

Advice:

Ensure that Max is taking the correct tablets in the correct doses. Determine if anyone has noticed him suffer a head injury recently. Have him assessed by a doctor, limiting his bodily movements until then to ensure his safety. Request that he be hospitalised if you feel adequate supervision cannot be arranged.

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