Instructions:

An 82 y.o. presents for follow-up of a recent URI. When asked about a bruise on his face, he says, “My feet got tangled up, and I fell on the way to the bathroom last night. I’m OK.” On further questioning, he says that he has been unbalanced on occasion, usually when he gets up in hurry. He has stumbled a few times but has usually been able to catch his balance and has never had a “bad injury.” He lives alone, and his daughter makes sure that there are no rugs or clutter that would cause him to slip. Otherwise, he feels well and says that the congestion and cough have cleared up.

Past Medical History
• Hypertension onset in 50s
• Osteoarthritis onset at 65
• Diabetes onset at 58
• Bilateral hip replacements at ages 75 and 77
• Prostate cancer, s/p prostatectomy at age 68

Current Meds
• Enalapril/HCTZ
• Celecoxib
• Metformin
• MTV

Family History
• Both parents, hypertension
• Father, stroke at age 75
• Mother, diabetes most of life, stroke at age 80, breast cancer
• Sister, hypertension, breast cancer

Psychosocial History
Has lived alone since wife died 10 years ago. Currently lives in a ground-level apartment since moved to area to be closer to daughter 5 years ago. Quit smoking at about 60 years of age. Alcohol very rarely consumed. Exercise consists of walking dog three to four times a day. Prepares “easy” foods for self for most meals. Drives to get groceries and to visit daughter, but not more than five to six miles a week.

Physical Examination
• Vital signs: T 97.3, BP 124/76, HR 66, HT 70, WT 189 lbs.
• General: Well oriented and pleasant. Bruised area right cheek. No other skin changes visible.
• CV: Neck–no bruits. Heart–RR&R, grade 1 innocent murmur present (previously identified). Pulses 2+. No edema.
• Lungs: Good expansion with clear breath sounds.
• MS: ROM upper extremities slightly limited elevation, internal and external rotation, but otherwise within normal limits. DIP joints with firm nodules. Strength upper extremities symmetrical and 4/5. Back forward flexion to 60 to 70 degrees with slight imbalance. Knee flexion slightly beyond 90 degrees. Extension bilaterally not quite to 180 degrees. Well-healed midline scars bilateral knees. Hip ROM within normal limits. Ankles full ROM. Strength legs symmetrical and 2–3/5.

Questions
1. What contributing factors should be considered relevant to the patient’s presentation and WHY? List at least three contributing factors.

2. What further history, further reexamination, and diagnostic studies are warranted to evaluate your differential diagnosis and WHY?

Struggling with where to start this assignment? Follow this guide to tackle your assignment easily!

Writing your paper can feel overwhelming, but if you follow these step-by-step instructions, you can structure a clear, logical, and well-supported paper.

Step 1: Understand the Case

Read the patient case carefully at least twice.
Highlight key details: age, recent fall, medical history, medications, physical exam findings.
Note any patterns, such as previous stumbles, balance issues, or medications that could contribute to falls.

Step 2: Break Down the Questions

Question 1: Identify contributing factors. Look at medical history, medications, musculoskeletal function, and lifestyle.
Question 2: Identify further history, exams, and diagnostics. Think about gaps in the case (e.g., neurological assessment, lab tests, imaging).

Step 3: Create an Outline

Introduction
- Briefly summarize the patient case.
- State the purpose of your paper: evaluating fall risk in an elderly patient.
Contributing Factors
- List each factor (≥3) with an explanation of why it contributes to the patient’s condition.
- Include references to credible sources.
Further History & Examinations
- Describe what additional questions to ask (e.g., frequency of dizziness, history of fainting).
- Specify reexamination procedures (e.g., gait and balance testing, orthostatic vitals).
- List diagnostic studies (labs, imaging) and justify why each is necessary.
Conclusion
- Summarize key findings.
- Discuss the importance of evaluating fall risk in elderly patients.

Step 4: Write Each Section

Use clear, concise sentences.
Use headings and subheadings to organize your paper.
Support your points with references.
Include specific examples from the patient case.

Step 5: Cite Your Sources

Use reliable medical sources: textbooks, peer-reviewed journals, and reputable websites.
Example references:

Step 6: Review & Edit

Check that all questions are answered thoroughly.
Ensure your paper flows logically from introduction to conclusion.
Proofread for spelling, grammar, and formatting errors.
Make sure all sources are properly cited.

Step 7: Finalize Your Submission

Confirm that the title is concise and relevant.
Ensure that headings and subheadings clearly indicate each section.
Include a reference list at the end.

Understanding Fall Risk in Elderly Patients: Key Considerations