Thank you very much for asking me to see Ms. Doukogianis for a geriatric assessment. The main concern is that of falls. She is an 86-year-old woman who was born in Greece and came to Canada in the 1950s. She is a widow since 2004. She has 2 children, 1 son Anthony and another daughter in Greece. Her daughter-in-law Karen is with her for the interview today. She lives alone in a condominium. She speaks several languages including Greek, Italian and English. She is a retired restaurant owner. She has about 4 years of high school education. Thank you very much for the detailed notes and previous investigation results. These are very helpful in understanding her situation and the workup that she has had done before. The problem list is especially helpful. She has a history of falling starting about 5-6 years ago. There is no precipitating factor. She cannot help falling and it is not exactly clear whether she has associated loss of consciousness or not. Apparently she is drowsy and gets confused for a few minutes. It happens up to once a day and may happen while she is walking. There is no precipitating factor. On further asking, there seems to be brief periods of syncope at times but not with every fall. She went to Greece from June 16th to September 16th for 3 months. She had fallen 4 times there. She had been on the floor for up to 10 minutes. She is back from Greece it has not happened anymore. There, she was helped up by the paramedics. She saw Dr. Randi Rose, our cardiologist in North York General Hospital and had a Holter for 2 weeks twice. There is some tremor but apparently no symptoms and no associated loss of consciousness or incontinence. As I look back into the history, there was a history of paroxysmal atrial fib... ... middle of paper ... ... subdural hematoma or other intracranial pathology. I would do a full metabolic workup for ruling out potentially reversible causes including CBC, electrolytes, BUN, creatinine, blood sugar, hemoglobin A1c, liver function tests, serum calcium, TSH and vitamin B12. No doubt the decrease in visual acuity and cognitive impairment would play a role in the pathogenesis of the falls and we will watch it closely. I would agree with checking up for cardiac causes of syncope as there is underlying right bundle branch block and left anterior hemiblock. Therefore, a Holter monitor should be done to rule out symptomatic arrhythmia. I will also book an EEG to rule out seizure disorder. We will observe her mood for now. She should see an eye specialist to further assess her vision. I will see her in 3 months’ time for followup, and thank you very much for referring this lady.