# Situation: The public health nurse of a municipality leads the health program for older persons in a farming barangay, working with the barangay health workers (BHWs) and the senior citizens' association. A 74-year-old man who takes a sedative sleeping pill every night completes the Timed Up and Go (TUG) test in exactly 12 seconds without a walking aid. He has never fallen. What should the nurse conclude and do? > source: MyMerci (mymerci.kr) > url: https://mymerci.kr/pages/nclex_q.php?qn_id=627070 > language: ko > subject: Nursing Practice I — Community Health Nursing ## 문제 Situation: The public health nurse of a municipality leads the health program for older persons in a farming barangay, working with the barangay health workers (BHWs) and the senior citizens' association. A 74-year-old man who takes a sedative sleeping pill every night completes the Timed Up and Go (TUG) test in exactly 12 seconds without a walking aid. He has never fallen. What should the nurse conclude and do? ## 보기 1. Borderline result; repeat the test next year before acting 2. Increased fall risk; begin balance work and a medicine review **✔ 정답** 3. Normal result, since his time did not go beyond 12 seconds 4. Increased fall risk; advise him to use a wheelchair outdoors **정답: 2** ## 해설 In the TUG test, taking 12 seconds or longer suggests increased fall risk, so a time of exactly 12 seconds is already above the cut-off. His nightly sedative is a second fall risk factor that calls for medication review. Fall prevention combines strength and balance exercise, medication review, a home hazard check, and vision correction; restricting mobility causes deconditioning. ## 심화 해설 The Timed Up and Go (TUG) test measures the seconds a person needs to rise from an armchair, walk 3 meters, turn, walk back, and sit down. It screens for mobility limitation and fall risk, not for a specific disease. In this case, the man completed the test in exactly 12 seconds without a walking aid. A time of 12 seconds or longer is interpreted as an indicator of increased fall risk, so a result of exactly 12 seconds should not be considered normal or merely borderline. The cut-off is not a range where 12 seconds is still safe; it is the threshold at which concern begins. The TUG result alone already places this man in a higher-risk category. However, the nurse must also consider the second, independent risk factor: nightly use of a sedative sleeping pill. Sedative-hypnotic medications such as benzodiazepines and Z-drugs are associated with falls and fall-related injuries in older adults. They can cause residual daytime sedation, slower reaction time, impaired balance, and reduced postural control, especially when combined with age-related changes in drug metabolism. When a person already has a TUG time at the threshold and also takes a sedative every night, the risk is compounded. The appropriate response is therefore not to wait a year or to reassure the patient, but to act now. The correct nursing conclusion is that this man has increased fall risk. The correct actions are to begin a balance and strength exercise program and to arrange a medication review. Balance training improves postural stability and functional mobility, which directly addresses the deficit revealed by the TUG. A medication review by the prescriber can determine whether the sedative dose can be reduced, changed to a safer alternative, or discontinued. This dual approach targets both the functional limitation and the modifiable pharmacological contributor. Watch out! A TUG time of exactly 12 seconds is not “normal” and not a reason to delay intervention. The cut-off is inclusive: 12 seconds or more means increased risk. Key point! Fall prevention in community-dwelling older adults is multifactorial. The core components include strength and balance exercise, medication review, a home hazard assessment, and vision correction. Restricting mobility by advising wheelchair use outdoors is not appropriate here because the man is still independently mobile, and unnecessary restriction leads to deconditioning, muscle weakness, and further functional decline. The evidence supports the predictive value of the TUG for fall risk in community-dwelling elderly populations. In a prospective cohort study, the TUG was evaluated as a screening tool for falls among community-dwelling older adults, and its accuracy was examined against fall outcomes [1]. A large cross-sectional study of over 6,000 community-dwelling elderly people in Shanghai also used the TUG to distinguish non-fall, single-fall, and recurrent-fall groups, reinforcing its role in fall screening [2]. These studies confirm that a slower TUG time is associated with a higher likelihood of falls, which is exactly the situation in this case. The medication concern is also well supported. A cross-sectional study of older patients presenting with falls found that sedative-hypnotic drug use was prevalent and was investigated for its association with fracture outcomes [3]. Another retrospective analysis of emergency department data examined the association between sedative-hypnotic use and fall-related visits among older adults [4]. Although findings on the strength of this association can vary across settings, the clinical principle remains that sedative-hypnotic use is a modifiable risk factor that should be reviewed in any older adult with other indicators of fall risk. In this patient, the combination of a borderline-abnormal TUG and nightly sedative use makes medication review a necessary part of the care plan. The nurse should also involve the barangay health workers and the senior citizens’ association in delivering the exercise program and in monitoring adherence. A simple, progressive balance and strengthening routine can be done in the community setting. The nurse should coordinate with the prescribing physician for the medication review rather than independently stopping or changing the drug. The goal is to reduce fall risk while preserving the man’s independence and mobility, not to impose restrictions that would accelerate decline.References (research sources) - [1]Accuracy of Timed Up and Go Test for screening risk of falls among community-dwelling elderly.Research articleAlexandre TS, Meira DM, Rico NC, Mizuta SK (2012) · DOI: 10.1590/s1413-35552012005000041 - [2]The Application of 'Timed up and Go' Test in Fall Screening of Elderly People in Shanghai: A Cross-Sectional Study.Research articleWang J, Chen X, Sun X, Ma H, Yu Y, Yao C (2021) · DOI: 10.18502/ijph.v50i12.7940 - [3]Sedative-hypnotic drug use and risk of falls and fractures in elderly patients: a cross-sectional study.Research articleImani MH, Imani AH, Saem A, Niksolat M. (2025) · DOI: 10.1186/s12877-025-06624-y - [4]Association Between Sedative-Hypnotic Medication Use and Fall-Related Emergency Department Visits Among Older Adults.Research articleOladimeji A, Opoku KA, Dockery A, Alcin D, Ofochukwu VC, Osueni A, Okobi EK. (2026) · DOI: 10.7759/cureus.107830 ## 임상 시나리오 TUG 12 Seconds in an Older Adult on a Nightly SedativeAct now: balance training and medication review A Timed Up and Go (TUG) time of 12 seconds or longer indicates increased fall risk, so exactly 12 seconds is already above the safe threshold, not normal or borderline. Nightly use of a sedative-hypnotic is an independent fall risk factor. It can cause residual sedation, slower reaction time, and impaired postural control, compounding the risk from the TUG result. Immediate actions are to begin a balance and strength exercise program and arrange a medication review. Fall prevention also includes a home hazard check and vision correction. CautionDo not advise wheelchair use or activity restriction; this causes deconditioning and worsens fall risk. Do not delay intervention for a year when the TUG is already at the cut-off. ## 핵심 개념 - **Timed Up and Go (TUG) test** — A screening test measuring the seconds needed to rise from a chair, walk 3 meters, turn, walk back, and sit down; 12 seconds or longer indicates increased fall risk. - **Sedative-hypnotic** — Medications such as benzodiazepines and Z-drugs that can cause residual sedation, impaired balance, and increased fall risk in older adults. - **Fall prevention** — Multifactorial interventions including strength and balance exercise, medication review, home hazard assessment, and vision correction. - **Deconditioning** — Loss of physical fitness and function from reduced mobility or activity, which can worsen fall risk. ## 같은 주제 문제 - [Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).An inf…](https://mymerci.kr/pages/nclex_q.php?qn_id=627053) - [Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).At the…](https://mymerci.kr/pages/nclex_q.php?qn_id=627054) - [Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).A 4-mo…](https://mymerci.kr/pages/nclex_q.php?qn_id=627055) - [Situation: A nurse handles the under-five clinic of a Barangay Health Station (BHS).An 11-…](https://mymerci.kr/pages/nclex_q.php?qn_id=627056) - [Situation: A public health nurse works at a Rural Health Unit (RHU) that has a basic emerg…](https://mymerci.kr/pages/nclex_q.php?qn_id=627058) - [Situation: A public health nurse works at a Rural Health Unit (RHU) that has a basic emerg…](https://mymerci.kr/pages/nclex_q.php?qn_id=627059) - [Situation: A public health nurse works at a Rural Health Unit (RHU) that has a basic emerg…](https://mymerci.kr/pages/nclex_q.php?qn_id=627060) - [Situation: During the twice-yearly Garantisadong Pambata week, a nurse at a Barangay Healt…](https://mymerci.kr/pages/nclex_q.php?qn_id=627061) --- More free questions: [기출문제](https://mymerci.kr/) _학습 참고용입니다. 실제 임상은 최신 지침과 소속 기관 프로토콜을 따르세요._