The causes of falls in older people are many and the reader is referred to textbooks of geriatric medicine for a full discussion. However, the old age psychiatrist needs to be aware that many psychotropic drugs precipitate falls through postural hypotension, with tricyclic antidepressants and neuroleptics being particular offenders. Neuroleptics induce parkinsonism, putting the patient at risk of tripping against rugs or items of furniture. The clinical implications of falls, especially in older women, are serious because patients are at risk of a fractured neck of femur or (less commonly) a subdural haematoma, both of which carry a high mortality.

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