“Just a bit lightheaded, dear”

"Just a bit lightheaded at my age" in an 82-year-old is postural hypotension until proven otherwise — not normal ageing — and the highest-yield intervention is almost always the MEDICATION review: here a storm of culprits (a newly added third antihypertensive, amlodipine, on top of ramipril and a thiazide, plus tamsulosin — licensed only for men, so its indication needs checking — and amitriptyline) in a frail woman eating and drinking little. Confirm it with a standing BP (NICE NG136: seated or lying, then after at least 1 minute standing; a systolic fall of 20 mmHg or more is significant), and offer the comprehensive falls assessment that NICE NG249 recommends after falls with injury or a long lie. The examinable hidden agenda is the concealed falls: she has fallen twice and told no one because she is terrified that admitting it means being "put in a home". The minimising — and the request to "tell my daughter I’m fine" — is fear, and the daughter’s worry is the reliable signal. The skill is to refuse the ageing dismissal, build trust to uncover the falls, and reframe every intervention around PRESERVING independence (falls assessment and deprescribing are how she STAYS home), then address the wider frailty (nutrition, hydration, mood, isolation, bone health) and safety-net concretely (pendant alarm, "can’t get up = 999"). Risk reduced, dignity protected.