An 80-year-old Caucasian female is being discharged from the hospital after surgical repair of the right hip fracture. She fractured her right hip after falling down the steps in her home. She has a past history of osteoporosis, hypertension controlled with thiazide diuretics and metoprolol, diabetes mellitus treated with metformin, and hypercholesterolemia controlled with simvastatin. She suffered from an acute myocardial infarction six years ago, but she has not had any complications or recurrence of symptoms. She has a 50-year-old daughter who lives near her house. You advise the patient to consider an alternate living arrangement; however, she clearly expresses her desire to live by herself in her own home. She does not want to live in her daughter's house or in a nursing home. Which of the following is the most appropriate next step?

Question

An 80-year-old Caucasian female is being discharged from the hospital after surgical repair of the right hip fracture.  She fractured her right hip after falling down the steps in her home.  She has a past history of osteoporosis, hypertension controlled with thiazide diuretics and metoprolol, diabetes mellitus treated with metformin, and hypercholesterolemia controlled with simvastatin.  She suffered from an acute myocardial infarction six years ago, but she has not had any complications or recurrence of symptoms.  She has a 50-year-old daughter who lives near her house.  You advise the patient to consider an alternate living arrangement; however, she clearly expresses her desire to live by herself in her own home.  She does not want to live in her daughter's house or in a nursing home.  Which of the following is the most appropriate next step?

Quizplus · Accepted Answer

Explanation: Falls are a common cause of morbidity and mortality in the elderly population. These are associated with injuries and fractures, significant decline in functional status, and subsequent greater chance of nursing home placement. Falls in the elderly population occur as a result of a mixture of intrinsic and extrinsic factors. The intrinsic factors include any acute illness or an age-related decline in balance, vision, ambulation, proprioception, cognitive impairment, musculoskeletal or cardiovascular function. Some of the extrinsic stressors that can lead to an increased risk of falls include the use of multiple medications, psychotropic medications, and an unsafe home environment. Prevention of recurrent falls and the associated complications is important in patients with a history of prior falls. Some interventions that have been proven to be useful in the prevention of falls include muscle strength and balance training, withdrawal of psychotropic medications, and home hazard evaluation and modification by a trained professional. Therefore, the patient in the above vignette should have a total assessment and modification of her home environment to reduce the risk of subsequent falls. (Choices A, B & E) The patient appears competent and does not wish to live in the nursing home or with her daughter. She should not be forced by the physician or her daughter to move to the nursing home or her daughter's house. Educational Objective: Some interventions that have been proven to be useful in the prevention of falls in elderly patients include muscle strength and balance training, withdrawal of psychotropic medications, and home hazard evaluation and modification by a trained professional.

An 80-Year-Old Caucasian Female Is Being Discharged from the Hospital