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

question 59

Multiple Choice

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?

• A)Geriatric depression scale
• B)Mini-mental status examination
• C)Right hand cane
• D)Visual acuity testing
• E)Vitamin B₁₂ level

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Definitions:

Liability

A legal responsibility or obligation, often involving the need to pay damages or restitution as a result of one's actions or failure to act.

Implied Warranty

A legal guarantee implied by law that ensures goods or services sold are of satisfactory quality and fit for their intended purpose.

Insurer

An entity that provides insurance, promising to cover a specific set of risks in exchange for a premium.

Implied Warranty

A legal guarantee that the product sold will be of satisfactory quality and fit for purpose, even if not explicitly stated.