An 80-Year-Old Man Comes to the Office Due to Generalized

An 80-year-old man comes to the office due to generalized weakness and intermittently feeling "dizzy" and unsteady over the past year.  He fell 9 months ago when he tripped over a step.  The patient has had no syncope or chest pain and has not attempted to use any mobility aids.  History is notable for hypertension, type 2 diabetes mellitus, hypercholesterolemia, osteoarthritis, coronary artery disease, and gastroesophageal reflux disease.  Current medications include metformin, glipizide, hydrochlorothiazide, aspirin, atenolol, simvastatin, and omeprazole.  The patient does not use tobacco or alcohol.
Blood pressure is 150/90 mm Hg and pulse is 68/min.  There are no orthostatic changes.  BMI is 30 kg/m².  Examination shows normal jugular venous pressure, clear lung fields, and normal S1 and S2.  The abdomen is soft and nontender.  There is no tenderness to palpation of the lower back.  There are symmetric joint deformities of both knees and generalized arthritic changes in both hands.  Cranial nerve examination is normal.  Muscle power is 4/5 in both upper and lower extremities.  Pinprick and light touch sensations are mildly decreased in both feet.  Achilles reflexes are absent bilaterally.
Complete blood count, basic metabolic panel, and vitamin D levels are normal.  Hemoglobin A1c is 8.2%.  ECG shows normal sinus rhythm and old Q waves in lateral leads.
Which of the following is the most effective strategy to decrease this patient's risk for falls?

A) Cardiac pacemaker
B) Education on fall prevention
C) Intensive blood glucose control
D) Intensive blood pressure control
E) Physical therapy

Correct Answer:

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