A Novel Approach to Proactive Primary Care–Based Case Finding and Multidisciplinary Management of Falls, Syncope, and Dizziness in a One-Stop Service: Preliminary Results

National and international evidence and guidelines on falls prevention and management in community dwelling elders recommend that falls services should be multifactorial, and their interventions multicomponent. The way in which patients are identified as having had, or being at risk of falls in order to avail of such services however is far less clear. We designed a novel multidisciplinary, multifactorial falls, syncope and dizziness service model with enhanced case ascertainment through proactive, primary care-based screening (of individual case notes of those age 60 years and over) for individual falls risk factors. Our service model identified 4039 individuals, of whom 2232 had significant gait and balance abnormalities per senior physiotherapist assessment. We uncovered significant numbers of patients with new diagnoses ranging from cognitive impairment through Parkinson’s disease to urgent pacemaker indications. We found more than 600 individuals who were at high risk of osteoporosis per FRAX score, 179 with benign positional paroxysmal vertigo and 50 with atrial fibrillation. Through such screening and our approach, Comprehensive Geriatric Assessment Plus (Plus falls, syncope and dizziness expertise), we targeted unmet need on a scale far outside the numbers seen in clinical trials. Further work is needed to determine whether this approach translates into improved falls, syncope and dizziness-related health improvement.