Elderly Woman Found On the Floor By Paramedics, On Furosemide, Wanting Only A Falls Alarm — Free SCA Practice Case

Character Overview: You are Joan, an 82-year-old widow who lives alone in a house with stairs. Yesterday you fell in the kitchen — you say you tripped. The paramedics checked you over and said to speak to your GP. You feel it was "just a trip" and you do not want a fuss; all you really want is a personal alarm pendant so you can call for help if it happens again. You are independent and slightly resistant to lots of assessments or changes. If the doctor listens and explains things kindly, you will agree to a proper check. You do get up several times at night to pass water (you take a water tablet), and you have had a couple of near-stumbles recently, but you play these down unless asked.

Opening Sentence: "Hello Doctor. The ambulance people said I ought to ring you after my little fall yesterday. Really, I just tripped — I don't want any fuss. I think all I need is one of those alarm pendants, in case I'm ever on the floor again and can't get up."

History if Asked (Data Gathering Phase)

• ●The fall: "I was in the kitchen and I just tripped and went down. I didn't black out — I remember it all. I managed to get myself up after a while."
• ●Playing it down: "It was just a trip, really. I don't want a big fuss made."
• ●Nocturia (only if asked): "Well, I'm up three or four times a night to the loo — I take a water tablet. I do rush to get there."
• ●Near-misses (only if asked): "I've had a couple of wobbles lately, nearly stumbled once or twice, but nothing came of it."
• ●What she wants: "Just the alarm pendant, I think. That would put my mind at rest."

ICE — Ideas, Concerns, Expectations

The patient does not volunteer this information unprompted. These responses surface only when the candidate directly explores her perspective.

• ●Ideas: Joan believes it was simply a mechanical trip, nothing more, and that no underlying problem needs looking into. "It was just a trip — I don't think there's anything wrong that needs poking into."
• ●Concerns: Beneath her playing-it-down, she is afraid of being on the floor unable to get help, and — though she may not say it — of losing her independence if a fuss is made. "My real worry is being stuck on the floor and no one knowing. And I don't want anyone saying I can't manage on my own."
• ●Expectations: She wants only a falls alarm and no more. "I just want the alarm pendant, that's all."

If Asked — Falls Assessment Screen

The patient answers these only when directly asked.

• ●If asked about blackout/loss of consciousness or dizziness before the fall: "No blacking out. I remember it. Maybe a touch light-headed when I stand up sometimes, but not before this fall."
• ●If asked about preceding symptoms (palpitations, chest pain, aura): "No palpitations or chest pain."
• ●If asked about how long she was on the floor: "Maybe twenty minutes before I got up."
• ●If asked about previous falls / near-misses: "A couple of near-stumbles recently, but no actual falls before this."
• ●If asked about nocturia/urgency and the water tablet: "Up several times a night, rushing to the loo — I'm on a water tablet."
• ●If asked about dizziness on standing (postural symptoms): "Sometimes a bit light-headed getting up from a chair or out of bed."
• ●If asked about vision, footwear, walking aids, home hazards: "My eyes aren't great, I've not had them checked in a while. I wear slippers indoors. No walking stick. There are a few rugs and it's a bit cluttered."
• ●If asked about alcohol, bones/previous fractures, memory: "I don't drink much. I broke my wrist a couple of years ago. My memory's fine."

Responses to Management (The Negotiation Phase)

• ●If the Doctor agrees to arrange the alarm but proposes a fuller assessment: "You'll sort the alarm? But you think I need checking over properly too? Why's that?" (The tested point is providing what she wants while negotiating a proper multifactorial falls assessment.)
• ●If the Doctor raises the water tablet as a contributor: "You think my water tablet might be part of the problem — the rushing to the loo and feeling light-headed?" (The tested point is recognising medication contribution and reviewing it.)
• ●If the Doctor recommends an in-person review (lying/standing BP, balance): "You want to check my blood pressure lying and standing, and my walking? I suppose that's sensible."
• ●If the Doctor discusses strength/balance and home safety: "Exercises and someone looking at my rugs and clutter? If it helps me stay in my own home, alright."
• ●If the Doctor raises bone health: "My bones? Because of my wrist before? What would that involve?"