An 84-year-old woman comes to the office due to a fall. She was walking through a hallway in the evening when she tripped and fell on her left hip. She had no symptoms preceding the fall and no loss of consciousness. The patient, who lives alone, lay on the floor for about an hour before her daughter found her. She sustained only minor bruising on her left side. The patient experienced a similar fall 8 months ago. Medical history is notable for osteoarthritis in the hands and knees, chronic low back pain, chronic constipation, and osteoporosis. Current medications include acetaminophen, docusate, calcium, vitamin D, and alendronate.
Blood pressure is 155/70 mm Hg supine and 150/73 mm Hg standing, and pulse is 78/min and regular. Crepitus is noted on flexion of the knees bilaterally. The hips have full range of motion bilaterally and normal log rolls. Muscle strength is normal in all extremities. Pinprick and light touch sensations are intact.
X-rays of the left hip and pelvis reveal no fractures.
Which of the following is the best next step to reduce this patient's risk for further falls?

Question

An 84-year-old woman comes to the office due to a fall.  She was walking through a hallway in the evening when she tripped and fell on her left hip.  She had no symptoms preceding the fall and no loss of consciousness.  The patient, who lives alone, lay on the floor for about an hour before her daughter found her.  She sustained only minor bruising on her left side.  The patient experienced a similar fall 8 months ago.  Medical history is notable for osteoarthritis in the hands and knees, chronic low back pain, chronic constipation, and osteoporosis.  Current medications include acetaminophen, docusate, calcium, vitamin D, and alendronate.
Blood pressure is 155/70 mm Hg supine and 150/73 mm Hg standing, and pulse is 78/min and regular.  Crepitus is noted on flexion of the knees bilaterally.  The hips have full range of motion bilaterally and normal log rolls.  Muscle strength is normal in all extremities.  Pinprick and light touch sensations are intact.
X-rays of the left hip and pelvis reveal no fractures.
Which of the following is the best next step to reduce this patient's risk for further falls?

Quizplus · Accepted Answer

11ec193a_9886_a046_853d_6b97e2990134_MD0002_00 Sensory disturbances (eg, impaired vision, decreased proprioception) are a common cause of falls in the elderly. Visual acuity can be assessed during an office visit and should be part of the initial multifactorial fall prevention assessment. Simple, low-risk interventions such as cataract removal can significantly reduce future risk of falling. Additional assessment for fall risk in elderly patients includes postural vital signs, balance and gait testing, and home hazard evaluation. Patients should have individualized exercise recommendations that include balance, strength training, aerobic conditioning, and stretching exercises. Some experts also advise measurement of vitamin D levels and supplementation for those with deficiency. (Choice A) Routine screening for depression is recommended for elderly individuals. However, depression has not been associated with significantly increased risk for recurrent falls. (Choice B) Although cognitive impairment is a known risk factor for falls, the timing and location of this patient's fall are more suggestive of a visual deficit than a cognitive disorder. (Choice C) Canes and walkers can improve balance and mobility for patients with certain conditions (eg, osteoarthritis). However, these devices are associated with an overall increase in fall risk and can lead to more severe injuries when a fall occurs. (Choice E) Although peripheral neuropathy caused by vitamin B₁₂ deficiency can lead to recurrent falls, this patient's normal peripheral sensory examination makes B₁₂ deficiency less likely. ₁₂ ₁₂ Educational objective: Sensory disturbances (eg, impaired vision) are a common cause of falls in the elderly. Visual acuity should be part of the initial fall prevention assessment. Additional assessment for fall risk in elderly patients includes postural vital signs, balance and gait testing, and home hazard evaluation. __________ References: Visual impairment and the incidence of falls and fractures among older people: longitudinal findings from the Blue Mountains Eye Study. (http://www.ncbi.nlm.nih.gov/pubmed/25370514)

An 84-Year-Old Woman Comes to the Office Due to a Fall