A 79-year-old man is referred after his third fall in 12 months. The most recent fall, in his bathroom at night, resulted in a Colles' fracture. He reports no spinning vertigo but a vague unsteadiness, worse in poor lighting and on uneven ground. Past medical history includes type 2 diabetes (HbA1c 7.4%), grade 1 cataracts bilaterally, and treated hypertension. Examination shows reduced vibration sense to the ankles, normal HIT, normal calorics, normal MRI brain. Visual acuity is 6/12 bilaterally.
CDP findings
SOT pattern vs normalMCT — medium-amplitude backward translationADT — sway energy across five trials per direction
Presbycusis produces symmetric downsloping high-frequency sensorineural hearing loss, often paralleling the multifactorial decline seen on CDP. Hearing aids in this group can indirectly aid balance — patients who hear environmental cues better orient more confidently, reducing fall risk modestly. The audiometric and CDP findings together support a multifactorial-decline management framework.
Single-best-answer
Which CDP finding pattern is most consistent with this picture, and how should it guide management?
Teaching point. Multifactorial elderly falls are common and rarely have a single attributable cause. CDP can document the contribution of each sensory and motor system, supporting a tailored management plan. The strongest evidence base supports multifactorial fall-prevention programmes combining exercise (especially balance training), medication review, vision optimisation, environmental modification, and treatment of underlying conditions.