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Opal Smith, an 80-year-old woman, comes to your office as a new patient. She has hypertension, type 2 diabetes (diet-controlled), osteoarthritis, and mild hearing loss. Mrs. Smith’s main reported symptoms are bilateral mild knee pain and some sense of unsteadiness on walking. She denies dizziness, postural symptoms, or falls in the past year. She takes lisinopril 10 mg daily, a multivitamin, calcium with vitamin D, acetaminophen as needed for pain, and diphenhydramine as needed for occasional insomnia. She has lived alone since her husband died 3 years ago. She still drives and has several friends with whom she visits. One of her friends suffered a fall several months ago and fractured a hip, from which she is still recovering. Mrs. Smith is somewhat worried about her own unsteadiness and risk for falls.
On exam, her blood pressure is 136/78 mmHg, pulse 72, weight 150 lbs (68 kg), and height 5 ft 5 in. She is mildly hard of hearing but communicates well. She has some mild crepitus on motion of her knees; her gait is slowed with short steps and is somewhat wide based. The rest of her examination is unremarkable, as are all routine laboratory tests. At the end of her examination, Mrs. Smith asks you for fall prevention recommendations.
1.What are Mrs. Smith’s major risk factors for falls?
2.What interventions would you recommend to minimize her risk?
