Requires detailed history to fully understand the pace (acute, subacute, chronic) of events and symptoms which the patient is experiencing. Exam and studies are used to further define the underlying problem.
Generalized weakness - which can occur with multiple medical disorders (e..g. heart failure, liver disease, chronic kidney disease, advanced lung disease, malignancies, HIV, other infections, anemia, hypo or hyperthyroidism, other endocrinopathies, etc.)
Visual or hearing problems
Orthostatic blood pressure related (cardiovascular or autonomic etiology)
Musculoskeletal disorders - in particular knee, hip, ankle osteoarthritis or other processes contributing to instability when standing/walking
Medication side effects: many meds can affect gait/blanance. Can occur as acute, chronic or acute on chronic. Also affected by clearance (e.g. renal, liver) and drug-drug interactions
Vitamin D deficiency in the elderly (causing weakness)
Cognitive disorders (dementia, delirium)
Combinations of any of above or coupled with primary neurological causes, in partic w/older patients
Risk Factors
Older age (higher risk for most of above issues)
Symptoms
Imbalance
Weakness in general
Falls - and if so, events that surround them as well as sequelae
DIzziness - and if so, precipitants, more detailed description
Physical Exam Findings
Vital signs might reflect orthostasis, if that's contributing
Vision and hearing screening test
Might look overall frail, if that's contributing, including overall weakness
Observe patient getting up and walking (providing support if needed to prevent falls)
Musculoskeletal findings, including: arthritis, joint abnormalities, antalgic (limping) gait, other issues that impact ability to bear weight/stand/walk
Neurological assessment: evidence muscle, neuromuscular, PNS or CNS processes
Tests
Cbc, chem 7, lfts, TSH, HIV/other assessments of infection
X-rays and other imaging if suspect joint issues
Formal hearing and vision assessments as indicated
Assessment for cognitive impairment as indicated
Other imaging and tests based on clinical suspicions - useful in ruling out contributions from other/occult toxic/metabolic processes