OsteoEd

Fall Prevention

An 83-year-old woman with known osteoporosis (recent T-score of -2.7) presents because she has fallen twice in the past 2 months. She denies light-headedness, loss of consciousness, or palpitations. Her falls have not been associated with incontinence or confusion.

• Meds:
  • Estrogen
  • diltiazem
  • simvastatin
• SH:
  • She lives in a group home for seniors
• PE:
  • Alert
  • wearing securely fitting sandals
  • BP 92/50
  • HR 68

Exam is otherwise normal.

Click one of the video links to view a patient talking about her fear of falling.

• QuickTime format
• RealMedia format

Click an answer under each question.

1. Which diagnostic test should you order?

   • Option A Holter monitor
   • Option B Echocardiogram
   • Option C EEG
   • Option D No diagnostic testing needed

2. What are risk factors for falls?

   • Option A A history of previous falls
   • Option B Low bone mass
   • Option C Unsteadiness on physical exam
   • Option D Unsteadiness on physical exam
   • Option E All of the above

3. How do you screen for unsteadiness on physical exam?

   • Option A Observe patient rising from a sitting position
   • Option B Perform a Romberg maneuver
   • Option C Observe gait
   • Option D All of the above

4. What interventions should be considered to prevent future falls?

   • Option A Proper footwear
   • Option B Exercise
   • Option C Home safety assessment
   • Option D Avoidance of sedatives
   • Option E All of the above

5. What specific interventions should you perform for this patient at this time?

   • Option A Order a home safety evaluation
   • Option B Recommend an exercise program
   • Option C Adjust her medications
   • Option D Review footwear
   • Option E Consider hip pad protectors

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