Thank you very much for asking me to see Ms. Doukogianis for a geriatric evaluation. The main concern is falls. She is an 86-year-old woman, born in Greece and arrived in Canada in the 1950s. She has been widowed since 2004. She has 2 children, 1 son Anthony and another daughter in Greece. Her daughter-in-law Karen is with her for today's interview. She lives alone in a condominium. She speaks several languages ​​including Greek, Italian and English. She is a retired restaurateur. She has about 4 years of high school. Thank you very much for the detailed notes and results of previous investigations. These are very useful for understanding her situation and the assessment she has made previously. The problem list is particularly useful. She has a history of falls that started about 5-6 years ago. There is no triggering factor. She can't stop herself from falling and it's unclear whether she lost consciousness or not. Apparently she is sleepy and confused for a few minutes. This happens up to once a day and can happen while she is walking. There is no triggering factor. Upon further questioning, there appears to be brief periods of syncope at times, but not with every fall. She went to Greece from June 16 to September 16 for 3 months. She had fallen there 4 times. She was on the ground for 10 minutes. She's back from Greece, this hasn't happened again. There she was helped by paramedics. She saw Dr. Randi Rose, our cardiologist at North York General Hospital and had a Holter monitor for 2 weeks on two occasions. There is some tremor but apparently no symptoms and no associated loss of consciousness or incontinence. Looking back at the history, there was a history of paroxysmal atrial fibrillation... middle of paper ... subdural hematoma or other intracranial pathology. I would do a complete metabolic workup to rule out potentially reversible causes, including CBC, electrolytes, BUN, creatinine, blood glucose, hemoglobin A1c, liver function tests, serum calcium, TSH, and vitamin B12. There is no doubt that reduced visual acuity and cognitive impairment would play a role in the pathogenesis of falls and we will monitor them closely. I would agree to look for cardiac causes of the syncope because there is an underlying right bundle branch block and left anterior hemiblock. . Therefore, a Holter monitor should be performed to rule out symptomatic arrhythmia. I will also book an EEG to rule out any seizure disorders. We will observe his mood for now. She should see an ophthalmologist to further evaluate her vision. I will see her in 3 months for a follow-up, and thank you very much for referring this lady.