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ABFM Geriatric Medicine study materials
ABFM Geriatric Medicine study resources

ABFM Geriatric Medicine practice questions

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Question 1Aging and normal physiologic changes

Which renal change is expected in a healthy 80-year-old?

  1. Reduced concentrating ability Correct answer.
  2. Increased renal plasma flow
  3. Increased creatinine clearance
  4. A rise in glomerular filtration rate

Explanation

Normal aging reduces renal medullary tonicity and the collecting duct response to antidiuretic hormone, so maximal concentrating capacity falls. Renal plasma flow and GFR also decline gradually after midlife; they do not rise with age.

Question 2Aging and normal physiologic changes

What is the primary cause of presbyopia in older adults?

  1. Ciliary muscle weakness
  2. Corneal opacity
  3. Lens stiffening Correct answer.
  4. Optic nerve degeneration

Explanation

Presbyopia results mainly from age-related hardening of the lens capsule and lens substance, which reduces accommodative amplitude. Ciliary muscle function is relatively preserved compared with lens elasticity.

Question 3Aging and normal physiologic changes

Which pattern of hearing loss is typical of presbycusis?

  1. Bilateral conductive loss with a normal audiogram
  2. Sudden unilateral sensorineural loss
  3. Bilateral high-frequency sensorineural loss Correct answer.
  4. Unilateral conductive loss at low frequencies

Explanation

Presbycusis is a symmetric, slowly progressive sensorineural hearing loss that begins at high frequencies. It reflects cochlear hair cell loss, strial atrophy, and neural degeneration.

Question 4Aging and normal physiologic changes

Which body composition change is characteristic of normal aging?

  1. An increase in lean body mass
  2. A decrease in total body fat
  3. More visceral fat, less muscle Correct answer.
  4. An increase in total body water

Explanation

Aging is accompanied by sarcopenia and a redistribution of fat toward the visceral compartment, even when body weight is stable. Total body water also tends to fall because lean mass holds most of the body's water.

Question 5Aging and normal physiologic changes

Which skin change is expected with normal aging?

  1. Dermal thinning and reduced sebum Correct answer.
  2. Progressive thickening of the dermis
  3. An increase in epidermal turnover
  4. An increase in sweat gland density

Explanation

Aged skin shows dermal thinning with loss of collagen and elastin, reduced sebaceous output, and fewer sweat glands. These changes impair barrier function and thermoregulation.

Question 6Aging and normal physiologic changes

Which immune change is most characteristic of aging?

  1. Enhanced antibody response to new vaccines
  2. Thymic output that increases with age
  3. Increased naive T-cell production
  4. Impaired T-cell-mediated immunity Correct answer.

Explanation

Immunosenescence includes thymic involution, reduced naive T-cell output, and impaired cell-mediated responses, which lower vaccine efficacy. Innate immunity is comparatively better preserved.

Question 7Aging and normal physiologic changes

Which cardiovascular change is typical of healthy vascular aging?

  1. A decrease in systolic blood pressure
  2. Stiffer arteries, wider pulse pressure Correct answer.
  3. An increase in diastolic blood pressure
  4. An increase in resting heart rate

Explanation

Large-artery stiffening reduces the buffering function of the aorta, raising systolic pressure and lowering diastolic pressure, so pulse pressure widens. Resting heart rate and cardiac output at rest are usually unchanged.

Question 8Aging and normal physiologic changes

Which metabolic change is expected in an older adult without diabetes?

  1. Increased peripheral insulin sensitivity
  2. Decreased hepatic glucose output
  3. Increased beta-cell mass
  4. Peripheral insulin resistance Correct answer.

Explanation

Aging is associated with reduced insulin sensitivity in skeletal muscle and a blunted early insulin secretory response. These changes raise postprandial glucose even when fasting glucose remains near normal.

Question 9Aging and normal physiologic changes

Which pulmonary change occurs with normal aging?

  1. An increase in chest wall compliance
  2. Reduced elastic recoil, higher residual volume Correct answer.
  3. An increase in vital capacity
  4. An increase in diffusing capacity

Explanation

Aging reduces lung elastic recoil and stiffens the chest wall, so residual volume rises and vital capacity falls. The alveolar surface area and diffusing capacity also decrease.

Question 10Aging and normal physiologic changes

How does normal aging affect drug metabolism?

  1. Increased hepatic blood flow
  2. Increased serum albumin
  3. Reduced phase I oxidation Correct answer.
  4. Increased first-pass metabolism

Explanation

Liver volume and hepatic blood flow decline with age, and cytochrome P450-mediated phase I oxidation is reduced. Phase II conjugation is relatively preserved, and serum albumin often falls.

Question 11Aging and normal physiologic changes

Why are older adults at greater risk of heat illness?

  1. Increased cutaneous vasodilation
  2. Increased sweating capacity
  3. Less sweating and vasodilation Correct answer.
  4. Enhanced shivering response

Explanation

Aging reduces sweat gland output and cutaneous vasodilation, limiting heat dissipation during exertion or hot weather. Thirst and renal concentrating ability also decline, increasing dehydration risk.

Question 12Aging and normal physiologic changes

Which sleep pattern is typical of older adults?

  1. Increased slow-wave sleep
  2. Delayed sleep phase
  3. Fragmented sleep with an earlier phase Correct answer.
  4. An increase in total sleep time

Explanation

Aging reduces slow-wave sleep and increases nighttime awakenings, while circadian timing advances so sleepiness comes earlier. Total sleep time tends to decrease slightly.

Question 13Aging and normal physiologic changes

Which bone change is characteristic of normal aging in women?

  1. Decreased bone turnover
  2. Trabecular bone loss Correct answer.
  3. Increased osteoblast activity
  4. Increased cortical thickness

Explanation

After menopause, estrogen deficiency accelerates bone resorption, causing trabecular thinning and loss of connectivity. Cortical thinning also occurs, and bone turnover is often increased rather than decreased.

Question 14Aging and normal physiologic changes

Which muscle change underlies age-related strength loss?

  1. Increased motor unit number
  2. Type II fiber atrophy Correct answer.
  3. Increased muscle protein synthesis
  4. Hypertrophy of type I fibers

Explanation

Sarcopenia involves loss of motor neurons and preferential atrophy of fast-twitch type II fibers, reducing power and strength. Muscle protein synthesis also becomes blunted, especially after meals.

Question 15Aging and normal physiologic changes

Which lower urinary tract change is expected with aging?

  1. Increased bladder capacity
  2. Smaller bladder, detrusor overactivity Correct answer.
  3. Increased urethral closure pressure
  4. Increased detrusor contractility

Explanation

Aging reduces bladder capacity and increases uninhibited detrusor contractions, contributing to nocturia and urgency. Detrusor contractility often weakens, and postvoid residual volume may increase.

Question 16Aging and normal physiologic changes

Which sensory change is most prominent in older adults?

  1. Complete loss of sweet taste
  2. Preserved taste and smell
  3. Increased olfactory acuity
  4. Smell declines more than taste Correct answer.

Explanation

Olfactory receptor loss and neural degeneration reduce smell more than taste, and much of what patients call taste loss is actually flavor perception. Taste thresholds rise modestly, but complete taste loss is not a normal age change.

Question 17Aging and normal physiologic changes

An 82-year-old feels dizzy on standing. Which age-related mechanism contributes most?

  1. An increase in beta-adrenergic sensitivity
  2. An increase in arterial compliance
  3. Blunted baroreflex heart rate response Correct answer.
  4. Augmented carotid sinus sensitivity

Explanation

Aging reduces arterial and cardiopulmonary baroreflex sensitivity, so the heart rate response to standing is blunted. Older adults rely more on vasoconstriction, which also becomes less efficient.

Question 18Aging and normal physiologic changes

Why can serum creatinine underestimate renal impairment in a frail 80-year-old?

  1. Creatinine is actively secreted more with age
  2. Tubular reabsorption of creatinine increases
  3. Creatinine clearance exceeds GFR in the elderly
  4. Lower muscle mass reduces creatinine production Correct answer.

Explanation

Creatinine is generated from muscle creatine, so sarcopenia lowers production and can keep serum creatinine in the reference range despite a reduced GFR. Estimation equations that include age, sex, and weight partially correct for this.

Question 19Aging and normal physiologic changes

Which thyroid change is consistent with normal aging?

  1. A fall in TSH below the reference range
  2. Slightly higher TSH, normal free T4 Correct answer.
  3. A rise in free T4
  4. A rise in total T3

Explanation

Thyroid hormone clearance and production both decline with age, and TSH may drift upward slightly while free T4 remains normal. Subclinical hypothyroidism is more common, but overt thyroid disease is not a normal age change.

Question 20Aging and normal physiologic changes

Which statement about hemoglobin in older adults is correct?

  1. Anemia is an expected consequence of aging
  2. White blood cell count rises steadily with age
  3. A slight hemoglobin fall without anemia Correct answer.
  4. Platelet count increases markedly with age

Explanation

Population studies show a small age-related decline in hemoglobin, especially in men, but values below the reference range should prompt evaluation. Anemia in older adults often reflects iron deficiency, chronic kidney disease, or inflammation.

Question 21Geriatric assessment and functional status

Which of the following activities is classified as an instrumental activity of daily living (IADL)?

  1. Dressing
  2. Managing finances Correct answer.
  3. Bathing
  4. Toileting

Explanation

IADLs are the higher-order tasks that let an older adult live independently in the community, such as managing money, shopping, cooking, using transportation, and handling medications. Bathing, dressing, and toileting are basic self-care ADLs assessed by instruments such as the Katz Index.

Question 22Geriatric assessment and functional status

The Katz Index of Independence in Activities of Daily Living assesses which set of functions?

  1. Bathing, dressing, toileting, transferring, continence, feeding Correct answer.
  2. Gait speed, balance, and lower-extremity strength
  3. Shopping, cooking, finances, transportation, telephone use
  4. Memory, orientation, and executive function

Explanation

The Katz Index rates independence in six basic self-care functions: bathing, dressing, toileting, transferring, continence, and feeding. It does not measure instrumental tasks, mobility performance, or cognition.

Question 23Geriatric assessment and functional status

The Mini-Cog consists of which two components?

  1. An MMSE and a depression screen
  2. A verbal fluency task and a functional questionnaire
  3. A 10-item word list and a trail-making task
  4. A three-item recall and a clock-drawing test Correct answer.

Explanation

The Mini-Cog pairs a three-item recall with a clock-drawing task and takes only a few minutes to administer. Its brevity and reduced dependence on education and language make it useful at the bedside and in primary care.

Question 24Geriatric assessment and functional status

In the CAGE questionnaire for alcohol misuse, the letter "A" stands for which of the following?

  1. Abstinence from alcohol
  2. Annoyed by criticism Correct answer.
  3. Amount of alcohol consumed
  4. Anxiety about drinking

Explanation

CAGE is a four-item screen: Cut down, Annoyed by others' criticism of drinking, Guilty about drinking, and Eye-opener (morning drinking). Two or more affirmative answers suggest alcohol misuse, but the tool does not quantify intake or establish dependence.

Question 25Geriatric assessment and functional status

The 15-item Geriatric Depression Scale (GDS-15) was developed primarily to do which of the following?

  1. Diagnose bipolar disorder in older adults
  2. Screen for depression while avoiding confounding by somatic symptoms Correct answer.
  3. Assess caregiver burden
  4. Screen for cognitive impairment

Explanation

The GDS-15 was designed to screen for depression in older adults while excluding somatic symptoms such as fatigue, appetite change, and insomnia that often reflect medical illness rather than mood. It is a screening instrument and does not by itself confirm the diagnosis.

Question 26Geriatric assessment and functional status

The Confusion Assessment Method (CAM) is used to do which of the following?

  1. Screen for alcohol withdrawal symptoms
  2. Stage the severity of a known dementia
  3. Measure basic functional independence
  4. Detect delirium at the bedside Correct answer.

Explanation

The CAM identifies delirium when there is acute onset with a fluctuating course plus inattention, along with either disorganized thinking or an altered level of consciousness. It is the most widely used bedside delirium screen and is often incorporated into the 4AT.

Question 27Geriatric assessment and functional status

An 82-year-old woman takes 15 seconds to complete the Timed Up and Go (TUG) test. This finding most likely indicates which of the following?

  1. Cognitive impairment
  2. Peripheral neuropathy
  3. Normal mobility for her age
  4. Increased risk of falling Correct answer.

Explanation

A TUG time of 12 seconds or longer is the usual threshold that flags increased fall risk in community-dwelling older adults, and times of 20 seconds or more suggest a substantial mobility deficit. The test measures mobility and balance rather than cognition or nerve conduction.

Question 28Geriatric assessment and functional status

A 78-year-old with 12 years of education scores 20/30 on the MMSE. This score is most consistent with which of the following?

  1. Normal cognition
  2. Mild cognitive impairment
  3. Delirium
  4. Moderate impairment Correct answer.

Explanation

An MMSE score below 24 generally indicates cognitive impairment, with scores in roughly the 10-to-20 range falling in the moderate band. The MMSE does not identify the cause of impairment and cannot distinguish delirium from dementia without corroborating history.

Question 29Geriatric assessment and functional status

A patient can bathe, dress, and feed himself but needs help with medications, finances, and transportation. This pattern indicates which of the following?

  1. Delirium superimposed on an established dementia
  2. Impaired basic ADLs with intact IADLs
  3. Global decline with no spared function
  4. Intact basic ADLs with impaired IADLs Correct answer.

Explanation

Basic self-care is preserved while the more complex community-living tasks are lost, which is the classic early functional pattern in mild cognitive impairment and early dementia. IADLs are typically lost before basic ADLs in progressive cognitive decline.

Question 30Geriatric assessment and functional status

A gait speed of 0.6 m/s in an older adult is best interpreted as which of the following?

  1. Suggestive of Parkinson disease
  2. Normal for age
  3. A frailty marker Correct answer.
  4. An unreliable clinic measure

Explanation

Gait speed below 0.8 m/s is a component of the frailty phenotype and predicts falls, disability, hospitalization, and mortality; values near or below 0.6 m/s indicate severe mobility limitation. A standardized 4-meter course gives a reliable single measurement.

Question 31Geriatric assessment and functional status

The Braden Scale is used to estimate a patient's risk of which of the following?

  1. Falls
  2. Pressure ulcers Correct answer.
  3. Malnutrition
  4. Delirium

Explanation

The Braden Scale scores sensory perception, moisture, activity, mobility, nutrition, and friction or shear, with lower total scores indicating higher pressure injury risk. Fall risk is assessed with tools such as the Morse Fall Scale, and nutrition with tools such as the MNA-SF.

Question 32Geriatric assessment and functional status

The Zarit Burden Interview is designed to assess which of the following?

  1. Patient depression
  2. Functional independence
  3. Cognitive reserve
  4. Caregiver burden Correct answer.

Explanation

The Zarit Burden Interview quantifies the perceived emotional, physical, and financial strain experienced by a family caregiver. High scores identify caregivers who may need respite, support services, or their own clinical evaluation.

Question 33Geriatric assessment and functional status

When discussing advance care planning with an older adult who has mild functional decline, the most appropriate initial step is which of the following?

  1. Defer the discussion until the patient is unable to participate
  2. Complete a POLST form immediately at this visit
  3. Explore values and goals of care Correct answer.
  4. Focus the visit on medication reconciliation instead

Explanation

Advance care planning starts with understanding the patient's values, goals, and priorities while he or she can still participate; specific documents such as advance directives or a POLST follow from that conversation. Deferring the discussion until decisional capacity is lost removes the patient's own voice from the process.

Question 34Geriatric assessment and functional status

A 70-year-old college graduate reports word-finding difficulty but scores 28/30 on the MMSE. Which test is most likely to detect early executive dysfunction?

  1. Mini-Cog
  2. Montreal Cognitive Assessment Correct answer.
  3. Geriatric Depression Scale
  4. Repeat the MMSE in six months

Explanation

The MoCA was designed to be more sensitive than the MMSE to mild cognitive impairment, particularly executive and visuospatial dysfunction, and avoids the MMSE's ceiling effect in highly educated patients. Repeat testing in six months delays evaluation, the Mini-Cog is less sensitive to mild executive deficits, and the GDS-15 screens mood only.

Question 35Geriatric assessment and functional status

The Mini Nutritional Assessment Short Form (MNA-SF) is used to do which of the following?

  1. Estimate renal function
  2. Screen for malnutrition Correct answer.
  3. Grade pressure injury severity
  4. Measure lower-extremity strength

Explanation

The MNA-SF combines appetite and intake decline, weight loss, mobility, acute illness or stress, neuropsychological status, and BMI or calf circumference to classify nutritional risk. It is a screening tool that should trigger a fuller assessment when the score is low.

Question 36Geriatric assessment and functional status

The SPICES framework is used to screen for which set of geriatric syndromes?

  1. Strength, posture, independence, cognition, endurance, sensation
  2. Sleep, eating, incontinence, confusion, falls, skin Correct answer.
  3. Sepsis, pneumonia, ischemia, cardiac events, embolism, stroke
  4. Sarcopenia, pain, insomnia, constipation, edema, syncope

Explanation

SPICES is a mnemonic screening framework covering Sleep disorders, Problems with eating or feeding, Incontinence, Confusion, Evidence of falls, and Skin breakdown. It prompts systematic assessment of common geriatric syndromes rather than generating a severity score.

Question 37Geriatric assessment and functional status

An older adult meets three of the five Fried frailty criteria. How is this patient classified?

  1. Disabled
  2. Prefrail
  3. Robust
  4. Frail Correct answer.

Explanation

In the Fried phenotype, three or more of the five criteria define frailty, one or two define prefrailty, and zero defines robust. Disability is a separate concept defined by difficulty with activities of daily living and is not a category of the phenotype.

Question 38Geriatric assessment and functional status

A 76-year-old with two years of formal education scores 22/30 on the MMSE. Which next step is most appropriate?

  1. Repeat the MMSE in 30 minutes
  2. Use an education-adjusted cognitive screen Correct answer.
  3. Diagnose dementia from the score
  4. Order an MRI and begin treatment empirically

Explanation

MMSE scores are strongly influenced by education, and a low score in a person with limited schooling may reflect educational background rather than cognitive loss. An instrument less dependent on education, such as the Mini-Cog, or formal neuropsychological testing is preferred before labeling impairment. A single screening score never establishes a dementia diagnosis.

Question 39Geriatric assessment and functional status

In a patient with advanced dementia and severe ADL dependence, which functional assessment tool is most appropriate?

  1. Katz ADL index Correct answer.
  2. Mini-Cog
  3. Timed Up and Go
  4. Lawton IADL scale

Explanation

In advanced dementia, IADLs are uniformly lost and cognitive screens cannot be completed meaningfully, so assessment focuses on basic ADLs such as bathing, dressing, toileting, transferring, continence, and feeding. The Katz Index and the MDS-ADL used in nursing homes quantify dependence at this stage and guide care planning.

Question 40Geriatric assessment and functional status

A patient's Barthel Index rises from 40 to 60 after a course of rehabilitation. This change is best interpreted as which of the following?

  1. Need for nursing home placement
  2. Clinically meaningful improvement Correct answer.
  3. A decline in function
  4. No clinically meaningful change

Explanation

The Barthel Index runs from 0 to 100, and changes of roughly 10 points or more are generally regarded as clinically meaningful, so a rise from 40 to 60 represents a real gain in independence. The score by itself does not determine placement, which also depends on caregiver capacity, safety, and patient preference.

Question 41Falls, gait, and balance disorders

Which test is recommended as a quick screening tool that combines gait and balance and measures the time to rise from a chair, walk 3 meters, turn, and return?

  1. Timed Up and Go test Correct answer.
  2. Six-minute walk test
  3. Berg Balance Scale
  4. Romberg test

Explanation

The Timed Up and Go test times a person rising from a chair, walking 3 meters, turning, and sitting back down. A time of about 12 seconds or more suggests increased fall risk. It is the most widely used brief combined gait-and-balance screen in older adults because it requires no special equipment and takes under two minutes.

Question 42Falls, gait, and balance disorders

What daily vitamin D intake is recommended for older adults at increased risk of falls?

  1. 2,000 IU
  2. 200 IU
  3. 5,000 IU
  4. 800 to 1,000 IU Correct answer.

Explanation

Geriatric guidelines recommend at least 800 IU of vitamin D daily for older adults at risk of falls, especially those with limited sun exposure or low intake. This dose improves muscle function and reduces falls and fractures in deficient patients. Very high doses, particularly 4,000 IU or more daily, have been associated with increased falls.

Question 43Falls, gait, and balance disorders

Which medication class is most consistently associated with falls in older adults?

  1. Benzodiazepines Correct answer.
  2. Proton pump inhibitors
  3. Thiazide diuretics
  4. Statins

Explanation

Benzodiazepines and related Z-drugs impair balance, reaction time, and cognition and are among the drug classes most strongly linked to falls and hip fracture. They appear on the Beers criteria as potentially inappropriate in older adults, particularly those with a fall history. Gradual tapering lowers fall risk.

Question 44Falls, gait, and balance disorders

Orthostatic hypotension is defined as a fall in blood pressure of at least which amount within 3 minutes of standing?

  1. 20 mm Hg systolic or 10 mm Hg diastolic Correct answer.
  2. 30 mm Hg systolic only
  3. 10 mm Hg systolic or 5 mm Hg diastolic
  4. 15 mm Hg diastolic only

Explanation

Orthostatic hypotension is a sustained drop of at least 20 mm Hg systolic or 10 mm Hg diastolic within 3 minutes of standing or head-up tilt. Blood pressure should be measured after lying for at least 5 minutes and again at 1 and 3 minutes of standing. Symptoms such as lightheadedness support the diagnosis and guide treatment.

Question 45Falls, gait, and balance disorders

Which change in gait is considered a normal consequence of aging?

  1. Steppage gait with foot drop
  2. Festinating gait with rapid small steps
  3. Shorter step length with longer time in double support Correct answer.
  4. Wide-based gait with stomping

Explanation

Normal aging produces a slower, more cautious gait with reduced step length, increased time in double support, and greater trunk flexion. These changes reduce gait efficiency but remain symmetric and stable. Any superimposed festination, wide-based ataxia, or foot drop indicates pathology rather than normal aging.

Question 46Falls, gait, and balance disorders

Which single intervention has the strongest evidence for reducing falls in community-dwelling older adults?

  1. Structured balance and strength exercise Correct answer.
  2. Vitamin D supplementation alone
  3. Home hazard modification alone
  4. Computerized cognitive training

Explanation

Exercise programs that challenge balance and build lower-extremity strength, such as tai chi or the Otago program, reduce falls by roughly 25 to 30 percent in community-dwelling older adults. Benefit requires ongoing participation, generally at least twice weekly. Exercise is the core of every major guideline recommendation.

Question 47Falls, gait, and balance disorders

An 80-year-old reports three falls in the past year without syncope or injury and takes eight medications. Which next step is most appropriate?

  1. Perform a multifactorial fall-risk assessment and act on identified factors Correct answer.
  2. Start a benzodiazepine for anxiety about falling
  3. Order magnetic resonance imaging of the brain
  4. Recommend bed rest and a wheelchair for safety

Explanation

Recurrent falls in an older adult warrant a multifactorial assessment covering medication review, orthostatic blood pressure, vision, gait and balance testing, feet and footwear, cognition, continence, and home hazards. Interventions are then targeted to the factors found. This approach is recommended for high-risk patients and reduces falls more than single interventions.

Question 48Falls, gait, and balance disorders

A 76-year-old walks with a wide-based, unsteady gait and reports numbness of both feet. Examination shows reduced vibration and position sense at the toes. Which cause of the gait disorder is most likely?

  1. Chronic lacunar stroke
  2. Parkinson disease
  3. Normal pressure hydrocephalus
  4. Sensory ataxia from peripheral neuropathy Correct answer.

Explanation

Loss of proprioception from peripheral neuropathy produces a wide-based, unsteady gait that worsens in the dark or with eyes closed, and the Romberg sign is often positive. Evaluation should include glucose, vitamin B12, thyroid function, and review of neurotoxic medications. The feet should also be inspected for ulcers and deformity.

Question 49Falls, gait, and balance disorders

A 74-year-old taking warfarin for atrial fibrillation falls at home and strikes her head. She is alert and oriented with a normal neurologic examination but reports a mild headache. What is the most appropriate next step?

  1. Obtain a skull radiograph
  2. Discharge home with instructions to return if symptoms worsen
  3. Reverse anticoagulation before any imaging
  4. Obtain an urgent noncontrast head CT Correct answer.

Explanation

Anticoagulated older adults with head trauma have a substantially elevated risk of intracranial hemorrhage, and guidelines recommend urgent CT even when the neurologic examination is normal. Headache after impact further raises concern. Reversal agents are given urgently once bleeding is identified or when clinical suspicion is very high, not instead of imaging.

Question 50Falls, gait, and balance disorders

Which footwear characteristic is most appropriate for an older adult with balance impairment?

  1. Low heel with a thin, firm, non-skid sole and closed heel Correct answer.
  2. Thick, soft rocker-bottom soles
  3. Loose-fitting slippers worn indoors and outdoors
  4. Elevated heels with a narrow base

Explanation

A thin, firm sole maximizes proprioceptive feedback from the foot, while a low heel, closed heel counter, and secure fastening improve stability and reduce tripping. Shoes should be worn both indoors and outdoors. Thick soft soles, slippers, and elevated narrow heels all increase fall risk.