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.

Geriatrics Case Study Analysis-65yrs Old Male

Falls occur due to various reasons. The approach to management is multidisciplinary. In the case of Mr. Smith, I would proceed to use the Comprehensive Geriatric Assessment. It is a multidisciplinary evaluation and therapeutic process that distinguishes the clinical, psychosocial, and functional constraints of a delicate older individual (Garrard et al., 2020). It helps to create an organized management plan that boosts well-being with advancing age. Furthermore, it helps in short-term and long-term follow-up of patients. Pain assessment is also important for Mr. Smith. Acute pain can be dependably evaluated with numeric rating scales or visual analog scales. Other scales like the Berg Balance Scale, Falls Efficacy Scale, and Timed Up and Go Test can be used to assess balance, fear of falling, and mobility, respectively.

There are no definitive tests to assess individuals who have had a fall. However, the cause of a fall can be determined from history, physical examinations, and laboratory tests. Laboratory investigations include complete blood count, liver and renal function tests, inflammatory markers such as C-reactive protein and erythrocyte sedimentation rate, urinalysis, blood glucose, and electrolyte levels such as magnesium. Imaging investigations that can be done are chest radiography and computed tomography scans of the head.

The management of falls can be difficult. For groups of elderly individuals, a mix of therapies such as treatment regimen evaluation, a workout routine, Vitamin D supplements, and home environment evaluation has been recommended (Bolding & Corman, 2019). There are different causes of falls. Therefore, treatment is personalized based on the individual. It is also based on findings after history taking and physical examination. Mr. Smith’s treatment regimen should include a workout plan. It should also include a balanced diet, and supplements like vitamin D. Other components that can be included in his treatment regimen are home visits and visual aids.

Mr. Smith should also be screened for Alcohol Use Disorder (AUD). A standardized screening tool is used, and if the results are positive, a clinical assessment is done in addition to laboratory and imaging tests (Lisko et al., 2021). Laboratory tests include a complete blood count and liver function test. For imaging, an abdominal ultrasound can be performed. Mr. Smith can benefit from screening and brief one-on-one counseling sessions. The goal of the sessions is to moderate Mr. Smith’s alcohol consumption to reasonable levels that do not cause harm to him. Medication can also be given if indicated. Other treatment modalities, such as self-help groups, are also important.

References

Bolding, D. J., & Corman, E. (2019). Falls in the geriatric patient. Clinics in Geriatric Medicine, 35(1), 115-126. https://doi.org/10.1016/j.cger.2018.08.010

Garrard, J. W., Cox, N. J., Dodds, R. M., Roberts, H. C., & Sayer, A. A. (2020). Comprehensive geriatric assessment in primary care: a systematic review. Aging Clinical and Experimental Research, 32(2), 197-205. https://doi.org/10.1007/s40520-019-01183-w

Lisko, I., Kulmala, J., Annetorp, M., Ngandu, T., Mangialasche, F., & Kivipelto, M. (2021). How can dementia and disability be prevented in older adults: where are we today and where are we going? Journal of Internal Medicine, 289(6), 807-830. https://doi.org/10.1111/joim.13227.