Table 1.

 Multifactorial assessment and intervention protocol

Assessment	Risk factors identified	Intervention
Medical: history and examination, including review of drugs, visual acuity assessment, 12 lead electrocardiograph, short geriatric depression scale	General medical, drugs (psychotropic, culprit‡, polypharmacy), vision, depression, epilepsy, cerebrovascular	Appropriate investigation and management of untreated medical problems. Review and modification of psychotropic drugs, other culprit drugs, and polypharmacy. Optical correction by an optician or referral to an ophthalmologist. Formal psychogeriatric assessment
Cardiovascular*: measurement of morning orthostatic blood pressure, carotid sinus massage supine and tilted upright, prolonged head-up tilt9	Cardiovascular (orthostatic hypotension, cardioinhibitory carotid sinus hypersensitivity, vasodepressor carotid sinus hypersensitivity, vasovagal syncope)	Advice on avoiding precipitants and modification of drugs. Postural hypotension: compression hosiery, fludrocortisone, or midodrine.9 10 Cardioinhibitory carotid sinus hypersensitivity: permanent pacemaker.9 Symptomatic vasodepressor carotid sinus hypersensitivity or vasovagal syncope: fludrocortisone or midodrine9 10
Physiotherapy†: modified version of performance orientated mobility assessment,11 assessment of walking aids, feet, and footwear12	Feet and footwear, gait and balance	Supervised home based exercise programmes for 3 months (structured gait retraining, balance, transfer and mobility interventions; functional limb strengthening and flexibility exercises),12 to be continued by informant for duration of study. Provision of appropriate walking aids and footwear. Chiropody referrals as required
Occupational therapy: assessment of environmental fall hazards using a standard checklist13	Environmental fall hazards	Home hazard modification using standard protocol13

^*Blood pressure measured by digital photoplesthysmography using Finapres (Ohmeda). Heart rate changes recorded by continuous surface electrocardiography. 

^†Assessment modified to allow normal gait or balance achieved using walking aid to count as normal score. Gait and balance components scored separately: gait scored out of 18, abnormal score >9; balance scored out of 39, abnormal score >13. Physiotherapy assessment conducted in patient's home environment. 

^‡Known to cause abnormal heart rate or blood pressure responses.