Functional Status, Mobility, and Falls Prevention
Core concepts
Function is assessed through ADLs (bathing, dressing, toileting, transferring, feeding, continence) and IADLs (managing money, medications, transportation, shopping, cooking, housekeeping). Loss of IADLs often precedes ADL loss. Mobility screening includes the Timed Up and Go and gait/balance assessment. Falls are multifactorial: intrinsic factors (vision, neuropathy, cognition, orthostasis, medications) and extrinsic factors (lighting, rugs, footwear, assistive devices). A falls history is itself a risk factor. Prevention bundles include exercise (balance and strength), medication review, vision and footwear optimization, home safety, and vitamin D where appropriate. Understand that fear of falling and deconditioning create a downward spiral.
Traps
Questions test whether you screen for falls in every older adult and address modifiable causes rather than simply advising "be careful." A trap is attributing a fall to "just aging" or prescribing a restraint-like restriction instead of a multifactorial intervention. Another is missing orthostatic hypotension or a sedating medication as the cause.
Rule of thumb
A fall is a symptom, not a diagnosis-always look for the cause and address multiple modifiable factors.
Worked example
An 80-year-old reports two falls and takes a sedative at night. The best plan combines medication review (deprescribe the sedative), strength/balance exercise, and home safety assessment-multifactorial, not a single fix.