Mr. Smith is a 65 year old male
Mr. Smith is a 65-year-old male that is accompanied by his wife to your clinic. He is following up after an ER visit for a fall at home that resulted in 6 stitches to his forehead. He admits that he had a few drinks that night before tripping over his dog. His wife adds that he has “a few drinks” every night. Mr. Smith is a 65-year-old man who has come to your facility with his wife to receive treatment. He is following up after being sent to the emergency room after a fall at home that resulted in six stitches being placed in his forehead. Afterward, he admits to having a couple of drinks the night before stumbling over his dog. His wife adds that he has “a couple of beers” every night before bedtime.
How will you proceed with Mr. Smith? What diagnostics will you perform? What will potentially be part of your treatment plan?
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Available at: https://www.nice.org.uk/guidance/cg115. Accessed 15 Oct 2023.
Podsiadlo, D. and Richardson, S. (1991) ‘The timed “Up & Go”: a test of basic functional mobility for frail elderly persons’, Journal of the American Geriatrics Society, 39(2), pp. 142–148. Here is a draft paper on how to proceed with Mr. Smith based on the information provided:
Evaluating and Managing Risk of Falls in Older Patients: A Case Study
Introduction
Falls are a significant health issue among older adults, posing risks of injury, loss of independence, and even death (Centers for Disease Control and Prevention [CDC], 2022). Multiple intrinsic and extrinsic factors can contribute to falls in this population, including chronic conditions, mobility impairments, home hazards, and substance use (CDC, 2022). A comprehensive geriatric assessment is necessary to identify modifiable risk factors and guide an individualized treatment plan to reduce future fall risk.
Case Presentation
Mr. Smith is a 65-year-old male who presented to clinic for follow-up after an emergency room visit for a fall at home resulting in a forehead laceration requiring stitches. Upon further history, it was revealed that Mr. Smith had consumed alcohol prior to the fall, and his wife reported he drinks most nights. A full medical history, physical exam, and diagnostic testing were warranted to properly evaluate Mr. Smith and develop an appropriate treatment approach.
Diagnostic Evaluation
A medical history addressed any past injuries, illnesses, medications, and family history that could impact fall risk (Kumar et al., 2018). A physical exam checked for injuries from the recent fall and assessed balance, gait, vital signs, and signs of dehydration or alcohol withdrawal (Mayo Clinic, 2022). Laboratory tests evaluated organ function and damage from long-term alcohol use, including a complete blood count, metabolic panel, and liver and kidney tests (MedlinePlus, 2021).
A fall risk assessment considered factors like lower body weakness, vision or inner ear problems, chronic diseases, and polypharmacy (CDC, 2022). The Timed Up and Go Test gauged mobility and fall prediction (Podsiadlo and Richardson, 1991). The Alcohol Use Disorders Identification Test screened for potential alcohol use disorder given Mr. Smith’s history (Babor et al., 2001). Safety monitoring was also needed for any alcohol withdrawal.
Treatment Plan
The treatment plan aimed to modify intrinsic and extrinsic fall risk factors. Lifestyle changes focused on limiting alcohol, improving nutrition, increasing physical activity, and modifying home hazards (NICE, 2013; CDC, 2022). His chronic conditions and medications were optimized. Follow-up ensured ongoing recovery monitoring and reassessment of fall risks over time (NICE, 2013).
Conclusion
With aging comes an increased risk of falls, but comprehensive geriatric assessment can identify modifiable risk factors. For patients like Mr. Smith, addressing substance use, chronic disease management, and environmental modifications form the foundation of an individualized fall prevention strategy. Regular follow-up ensures ongoing risk mitigation.
References
Babor, T.F. et al. (2001)…
CDC (2022)…
Kumar, V. et al. (2018)…
Mayo Clinic (2022)…
MedlinePlus (2021)…
NICE (2013)…
Podsiadlo, D. and Richardson, S. (1991)…
