| Course | NU 627 Geriatric Healthcare |
|---|---|
| Unit | Unit 4 |
| Paper type | Multifactorial falls plan |
| Length | About 1,010 words, 6 pages |
| Format | APA 7 student paper |
| School | Herzing University |
| Program | MSN Family Nurse Practitioner |
| Updated | October 2026 |
Free sample paper for NU 627 Unit 4
Multifactorial Falls Risk Assessment and Prevention Plan for a 79-Year-Old Man With Two Falls at Night
Student Name
Department of Nursing, Herzing University
NU 627: Geriatric Healthcare
Instructor Name
February 13, 2026
Multifactorial Falls Risk Assessment and Prevention Plan for a 79-Year-Old Man With Two Falls at Night
Fall History in Detail
Mr. K. is a composite patient: 79, a former machinist, living with his wife in a house whose bedrooms are upstairs. He has fallen twice in four months. The first fall was at about 3 a.m. in December: he got up to urinate, stood, felt lightheaded, and fell sideways against the bedroom dresser, bruising his ribs. He did not lose consciousness and got up on his own after a few minutes. The second fall was at about 2 a.m. in February, on the way back from the bathroom in a dark hallway, when his slipper caught on a rug edge; he fell forward onto his hands and could not get up for about 20 minutes until his wife helped him. He is now afraid to walk at night and has started limiting his fluids in the evening. Both falls share three features: nighttime, a trip to urinate, and poor lighting. The second fall, with a long lie on the floor, raises the stakes, because inability to get up after a fall is itself associated with serious harm.
Contributors Assessed
Orthostatic blood pressure: present. Supine 146/82, standing at one minute 122/72 and at three minutes 124/74, a drop of 24 mm Hg systolic, with lightheadedness. Medications: present. Tamsulosin 0.4 mg nightly for benign prostatic hyperplasia, which can cause orthostatic hypotension; zolpidem 5 mg nightly for sleep, which impairs balance and alertness when he wakes at night; hydrochlorothiazide 25 mg daily, which increases nighttime urination and contributes to volume depletion. Nocturia: present, three to four times nightly. Vision: present; cataracts in both eyes, visual acuity 20/50 in each eye with glasses, and he removes his glasses at night. Footwear: present; loose backless slippers. Home environment: present; loose rugs in the hallway, no night lights, and the bathroom is 25 feet from the bedroom. Cognition: assessed and not a contributor; Mini-Cog 5 of 5. Continence: urgency, present. Feet: assessed; no deformity or neuropathy, and vibration sense intact at the toes. Fear of falling: present, and already changing his behavior. Alcohol: assessed; one beer on weekends, not a contributor.
Each contributor is recorded as present, absent, or not assessed, because a reader must be able to tell an absent risk from an unexamined one. Multifactorial assessment of this kind, followed by interventions targeted to the contributors found, is the approach recommended for older adults who have fallen (Montero-Odasso et al., 2022).
Gait and Balance, Measured
Timed Up and Go: 16 seconds, above the 12-second threshold commonly used to identify higher fall risk in screening pathways such as STEADI (Stevens & Phelan, 2013). Thirty-second chair stand: 8 stands without using his arms, below average for his age. Four-stage balance test: he held the tandem stance for only 4 seconds. Gait: slightly wide based, with reduced step length and a cautious pattern that may reflect fear as well as balance impairment.
Medications and the Deprescribing Link
The medication contributors are addressed as a deprescribing decision, not only as a falls issue. Zolpidem is tapered and stopped over two weeks, because it is the contributor most directly implicated in impaired balance during nighttime waking and is listed among drugs to avoid in older adults. Hydrochlorothiazide is changed to morning dosing and its necessity reviewed; his blood pressure is not low when supine, so the plan is to reduce rather than stop antihypertensives while monitoring standing readings. Tamsulosin is continued because it treats symptoms he values, but it is reviewed with his urologist, and he is told to sit up, feet on the floor, and wait a full minute before standing, then stand with a hand on the bedside rail his daughter plans to install. Each change is made separately, so its effect on sleep, urination, and blood pressure can be seen.
Interventions on Several Fronts
Exercise, specified by dose: a home-based balance and strength program modeled on the Otago Exercise Program, delivered first by a physical therapist over five home visits and then continued independently. Dose: 30 minutes, three times a week, including progressive balance exercises such as tandem stance and heel-to-toe walking and lower-limb strengthening with ankle weights, plus walking at least twice a week. Exercise programs that challenge balance and are performed for at least three hours a week reduce the rate of falls in community-dwelling older adults (Sherrington et al., 2019).
Home modification: an occupational therapy home safety assessment; remove the hallway rug; motion-sensor night lights from bed to bathroom; a grab bar in the bathroom; a bedside urinal for nights when he feels unsteady. Footwear: closed-back, nonslip slippers. Vision: referral to ophthalmology for cataract surgery evaluation, because clearer vision at night is one of the few contributors that can be substantially improved, and a habit of wearing glasses when getting up at night. Nocturia: review of evening fluid timing so he drinks earlier rather than less, and evaluation of his urinary urgency. Fear of falling: education on how to get up from the floor, practiced with the physical therapist, and a personal alarm pendant so that another long lie on the floor is less likely.
Referrals
Physical therapy, for gait and balance training and floor-rise practice. Occupational therapy, for the home assessment and equipment. Ophthalmology, for cataract evaluation. Urology, for review of tamsulosin and nocturia management.
Follow-Up and What Cannot Be Modified
Follow-up in four weeks to review orthostatic readings after the medication changes, sleep after the zolpidem taper, and adherence to the exercise program; repeat Timed Up and Go and chair stand at three months. Some contributors cannot be removed. His benign prostatic hyperplasia will continue to wake him at night, and his age-related decline in balance will not fully reverse. The plan compensates by making nighttime trips safer rather than eliminating them, and by building strength and balance so that a stumble is less likely to become a fall. His wife was included in the plan, since she is the person most likely to find him if he falls again.
References
Montero-Odasso, M., van der Velde, N., Martin, F. C., Petrovic, M., Tan, M. P., Ryg, J., Aguilar-Navarro, S., Alexander, N. B., Becker, C., Blain, H., Bourke, R., Cameron, I. D., Camicioli, R., Clemson, L., Close, J., Delbaere, K., Duan, L., Duque, G., Dyer, S. M., ... Masud, T. (2022). World guidelines for falls prevention and management for older adults: A global initiative. Age and Ageing, 51(9), Article afac205. https://doi.org/10.1093/ageing/afac205
Sherrington, C., Fairhall, N. J., Wallbank, G. K., Tiedemann, A., Michaleff, Z. A., Howard, K., Clemson, L., Hopewell, S., & Lamb, S. E. (2019). Exercise for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews, (1), Article CD012424. https://doi.org/10.1002/14651858.CD012424.pub2
Stevens, J. A., & Phelan, E. A. (2013). Development of STEADI: A fall prevention resource for health care providers. Health Promotion Practice, 14(5), 706-714. https://doi.org/10.1177/1524839912463576
Reading the NU 627 Unit 4 instructions
The Unit 4 assignment asks you to assess an older adult's fall risk and develop a prevention plan. Expect to take a detailed fall history, then assess contributors such as orthostatic blood pressure, vision, medications, gait and balance, footwear, home hazards, continence and cognition. Gait and balance should be measured with a validated test and threshold. The plan should address several contributors at once, and exercise should be specified by type, frequency and duration. Medication changes, referrals and home modifications are commonly required, along with follow-up. Many sections ask which risks cannot be changed. Cite current falls guidelines and exercise evidence in APA 7. The patient should be invented, and your section sets the page count. Some prompts also want a brief fall history format, so check before you begin.
How this NU 627 Unit 4 example is built
The plan opens with each fall described by time, place, activity and what happened after, which shows a nighttime pattern on the way to the bathroom. The contributors section measures orthostatic blood pressure at one and three minutes and records the symptom, then covers vision, nocturia, the sleep medication and the stair. Gait and balance are reported with the Timed Up and Go and its threshold. The medication section treats zolpidem as a deprescribing decision with a two-week taper and reviews another drug that may lower blood pressure. Interventions are grouped: exercise with sessions per week and minutes, a night light path and grab bars, footwear and a bedside urinal. Referrals to physical and occupational therapy and ophthalmology follow. The final section sets a four-week review and lists risks, such as age, that remain.
NU 627 Unit 4 rubric: what full points look like
Points in a Herzing falls plan rubric usually go to the fall history, assessment of risk factors, measurement of gait and balance, the intervention plan, referrals and follow-up, and evidence. History points require detail about circumstances, not just a count of falls. Assessment points depend on several contributors measured, including orthostatic readings done correctly. Measurement points require a validated test with its threshold and source. The intervention plan is where most of the points sit, and graders expect multifactorial actions, exercise specified by dose and medication changes. Referral and follow-up points go to named services and a review date. Evidence is scored on current falls guidelines and trials of exercise, cited in APA format. Writing points cover clarity and a plan the patient and family can follow.
Common NU 627 Unit 4 mistakes, and how to avoid them
Falls plans frequently lose points by addressing only one cause, such as recommending a walker, when the assessment found several. Students also write "exercise" or "balance training" without type, frequency or duration. Orthostatic blood pressure is often reported without timing or symptoms. Sleep medications and other drugs that raise fall risk are commonly mentioned but not changed. Another gap is a vague fall history that misses the pattern, here nighttime trips to the bathroom. Referrals without a purpose earn little. Follow-up is often missing. Finally, acknowledge what cannot be modified, since rubrics sometimes credit an honest statement of remaining risk and a plan to reduce injury if a fall does happen.
Get a NU 627 Unit 4 example written to your instructions
Send the Unit 4 instructions and the rubric from your NU 627 classroom, plus the patient case and any falls history you are working from. We write a custom example with a structured multifactorial assessment and an intervention specified by dose, returned in 24 to 48 hours. The first custom sample is free.
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NU 627 Unit 4 questions, answered
Why does the plan have to address several factors?
Because falls have several causes at once and the trial evidence favors multifactorial intervention. An older adult who falls typically has a combination of medication effect, balance impairment, vision change and an environmental hazard, and addressing one leaves the rest operating. Single-component plans read as incomplete to anybody who knows this literature.
How detailed should the fall history be?
Detailed enough to reconstruct the event. Time of day, what the patient was doing, whether there was warning, whether they could get up afterwards, and whether anybody was present all point at different mechanisms. A history recorded as two falls in six months discards nearly all the useful information the patient could have given you.
What does specifying exercise by dose mean?
Naming the type, how hard, how often and for how long. The programs with evidence behind them involve progressive balance challenge at a specific frequency sustained over months, which is a long way from advice to stay active. Write what the patient would actually do each week, and name the program or referral that would deliver it.
Where can I find a free NU 627 Unit 4 sample paper?
This page shows the full NU 627 Unit 4 falls plan for free, with the fall history, measured contributors, exercise by dose, referrals and follow-up. Want one written around your patient's falls? A custom plan is free and is usually delivered inside two days.
How do you assess fall risk in an older adult?
Take a detailed history of each fall, check orthostatic blood pressure, vision, medications, feet and footwear, continence and cognition, and measure gait and balance with a test such as the Timed Up and Go. Then address several contributors at once.