Assignment task:
Your patient is an active 85-year-old assisted living facility resident. She does all her cooking and participates in the facility activities. She has a long-term history of hypertension (HTN) that was associated with obesity, a sedentary lifestyle, and comorbid hyperlipidemia. Her family history includes common issues with HTN, but also longevity. She never smoked but admits to enjoying a glass of wine every night with dinner, as was the custom for her larger Italian family. She was brought up in a traditional household with many dishes that are now considered Mediterranean cuisine. She takes pride in following "doctor's orders" and takes her medications religiously. She no longer takes statins but remains on Lisinopril 40 mg daily. She has had multiple visits to her primary care provider (PCP) recently due to taking several "noninjury falls" associated with small bruises. Today she comes in for evaluation with a small laceration on her brow following another fall. Vital signs (VS) are 118/70; 88 and 20. She is afebrile and her weight is stable at 160 pounds. What is the first thing that comes to mind as the probable cause of her increasingly frequent falls? What are her family and personal health history traits that have been contributory to keeping her active and generally "healthy" at her age? Can the frequent falls be due to something other than orthostasis, but still be of a CV nature? What steps non-pharmacologic and pharmacologic are required to get her therapeutic plan under control, give the rationale why you chose certain treatment plans and not others, and provide the follow-up plan for the patient and why you made the decision?