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Role-play Demonstration

Comprehensive Multifactorial Falls Risk Assessment: Environmental Home Safety, Medication Review, Vision and Balance Assessment, Psychological Impact and Bone Health Optimisation Following a Colles Fracture

geriatricsHome VisitLifestyle Advicebeginner

Your Role — Nurse

Patient's Home (Home Visit)

Your 78-year-old patient was referred by the GP for a falls risk assessment following a fall at home that resulted in a Colles fracture. The patient lives alone and has become increasingly anxious and has reduced activity due to fear of falling. Past medical history: hypertension (ramipril), osteoarthritis, osteoporosis (on alendronic acid and calcium/vitamin D). The patient has had 2 falls in the past year. You are the community nurse conducting a comprehensive multifactorial falls risk assessment including environmental hazards, medication review, vision, balance, fear of falling psychology, and bone health optimisation.

  • •Greet the patient and assess overall wellbeing. Ask about the fall circumstances and establish the sequence of events. Ask about any prodromal symptoms: dizziness, palpitations, light-headedness.
  • •Perform home safety walkthrough: identify trip hazards (rugs, cords, clutter), poor lighting, slippery surfaces, lack of grab rails, unsafe footwear. Suggest specific modifications.
  • •Review medications: antihypertensives, diuretics, sedatives, and any recently changed medications. Check vision including glasses use and last eye test. Assess balance and gait using timed-up-and-go test.
  • •Discuss fear of falling: validate the psychological impact. Explain that reduced activity increases fall risk through muscle weakness. Recommend a falls prevention class and/or physiotherapy for balance and strengthening exercises.
  • •Discuss OT assessment for home equipment (raised toilet seat, grab rails, shower chair), pendant alarm, and what to do if they fall again. Review bone health: calcium, vitamin D, bisphosphonate adherence. Summarise the personalised plan with written instructions.

The Interlocutor

Played by the actor / assessor

You are 78 years old and live alone. You fell at home 3 weeks ago and broke your wrist. You have lost confidence and are anxious about falling again. You used to walk daily but have stopped. Your GP referred you for a falls assessment.

  • •Say you tripped on the rug in the dark while going to the toilet at night. You did not feel dizzy before the fall.
  • •Say you have stopped going for walks because you are scared of falling. You spend most of the day in your chair.
  • •Say you had your eyes tested 3 years ago. You take blood pressure tablets and tablets for osteoporosis.
  • •Ask about a pendant alarm — you have seen them advertised and wonder if they would help.
  • •Say you feel more confident now. You agree to the falls class and OT assessment.

Sample Role-play

0:00Listen to a model performance · 0:00
Nurse

Hello Mrs Brown. I am Sarah the community nurse. Thank you for letting me visit today. How have you been managing since your fall?

Greeting with name and role. Open-ended question.
Patient

Very nervous to be honest. I have lost my confidence completely since it happened and I keep thinking I am going to fall again every time I stand up.

Nurse

What you are describing is extremely common after a fall and we actually call it fear of falling. It is a very real issue that can reduce your quality of life. The important thing to know is that this fear can actually make you more likely to fall again because you start moving less your muscles get weaker and your balance gets worse. The good news is there is a lot we can do to help.

Use clinical term to validate. Explain mechanism linking fear to increased risk. Frame positively.
Patient

I used to walk every day but now I just stay in my chair.

Nurse

We will work on getting you walking safely again. Tell me exactly what happened when you fell so I can understand the circumstances.

Assess environmental factors.
Patient

I got up in the night to get a drink of water and I tripped on the rug in the living room. I did not put any lights on.

Nurse

Loose rugs are one of the most common causes of falls in the home. I would suggest we either remove that rug completely or put some non-slip tape underneath it. I would also recommend a small automatic LED night light that plugs into the socket in the hallway and another in the bathroom. These are simple changes that can make a significant difference to your safety.

Specific environmental solutions with rationale.
Patient

How do I know if my home is safe enough?

Patient

I will take the rug up. I should have done it years ago.

Nurse

There are also other factors we need to check. When did you last have your eyes tested? Good vision is important for balance and avoiding obstacles. I also want to review your medications because some of them can contribute to falls risk.

Extend assessment to intrinsic factors.
Patient

It has been about three years for my eyes. I take blood pressure tablets and water tablets.

Nurse

The water tablet increases how much urine you produce which may be why you are needing to get up during the night in the first place. I will speak to your GP about reviewing this. In the meantime let me check your balance quickly. Can you stand up from this chair without using your hands?

Identify specific medication contributing to nocturia. Assess balance.
Patient

I can but I am a bit unsteady.

Nurse

That is fine. I would recommend doing balance exercises daily for about ten minutes — things like standing on one foot while holding the kitchen counter and walking heel to toe across the room. I can also refer you to a local falls prevention class which includes supervised exercises and is a good way to meet people. I will also refer you to occupational therapy for a home safety assessment and equipment like a raised toilet seat.

Specific exercise recommendations. Referrals to class and OT.
Patient

What about those pendant alarms I see advertised on television?

Nurse

I can definitely arrange that for you. You wear it around your neck or wrist and if you fall and cannot get up you simply press the button and someone comes to help you. It gives you and your family peace of mind.

Explain pendant alarm clearly.
Patient

That would make me feel much safer.

Nurse

Let me summarise everything we have discussed. One remove the rug and install night lights. Two book an eye test. Three GP to review your medications particularly the water tablet. Four balance exercises daily for ten minutes. Five referral to the falls prevention class. Six occupational therapy for home equipment. Seven pendant alarm arranged. I will come back and see you in about four weeks to review how you are getting on with all of these changes.

Comprehensive seven-point summary with clear follow-up.
Patient

That is a lot of things but they all make sense. I feel much safer knowing there is a proper plan in place.

Nurse

I will arrange all of these referrals today. Here is my card if you need anything before my next visit.

Warm closing with encouragement and offer of ongoing support.

Useful Phrases

“Losing confidence after a fall is very common and very understandable.”
“Most falls happen at home — and most are preventable.”
“A simple night light in the hallway and bathroom can make a huge difference.”
“Let's look at your home together and identify any trip hazards.”
“Regular eye checks and a medication review are important parts of falls prevention.”

Clinical Background

Falls in the elderly are a major cause of morbidity and hospitalisation. Key risk factors: history of falls, muscle weakness, gait deficit, balance deficit, use of ≥4 medications (especially sedatives and antihypertensives), visual impairment, environmental hazards. Nursing interventions: multifactorial falls risk assessment, home safety assessment, medication review, vision check, footwear advice, balance exercises, and referral to falls prevention services.

Common Mistakes to Avoid

  • ✕Focusing only on environmental hazards without assessing intrinsic risk factors (medication, vision, balance).
  • ✕Telling the patient 'just be more careful' — this is unhelpful and implies blame.
  • ✕Not addressing the psychological impact — fear of falling leads to activity restriction and deconditioning.
Comprehensive Multifactorial Falls Risk Assessment: Environmental Home Safety, Medication Review, Vision and Balance Assessment, Psychological Impact and Bone Health Optimisation Following a Colles Fracture — OET Speaking Role-Play Demo | FP8Media OET