Falls

Question 1

Risk factors

Answer 1

• Hx of falls *** biggest risk
• Advanced age
• Frailty
• Para-transitions (transition of care, change of environment, etc)
• Lives alone/minimal support system
• Ambulation status
• Sensory deficits
• Number of meds
• Female
• Cog decline
• sleep

Question 2

Medical conditions

Answer 2

• Gait/Balance (PD, Alzheimer’s disease, obesity)
• Pain (neuropathy, atrophy, osteoarthritis, rheumatoid arthritis)
• Infections
• Organ function (renal Hepatic)
• Vascular (MI, AFib, TIA, hemophilia)
• CNS (depression, epilepsy, MS)
• Incontinence
• Malnutrition/dehydration (vitamin D deficiency)

Question 3

Antidepressants

Answer 3

TCAs and SSRI (Paroxetine is the worse)

Question 4

Benzos

Answer 4

• Avoid longer T1/2 drugs: Diazepam, clonazepam
• Although long vs short acting BZD have similar falls rate
• Taper SLOWLY: max 25% every 2 weeks, but likely much slower

Question 5

Sedative/hypnotics

Answer 5

• Zolpidem has anesthetic effects, incr falls risk

- All can impact balance, gait, and equilibrium

Question 6

Antipsychotics

Answer 6

First gen worse, but both are associated with falls

Question 7

Anticholinergic

Answer 7

• Incontinence: Oxybutynin is the worst offender
• Depression (see above)
• Parkinson’s Disease (PD): Benztropine and trihexyphenidyl

Question 8

Pain Therapy

Answer 8

• Opioids: impact balance, gait, equilibrium, Esp when using high potency, long acting, and new prescription
• Scheduled APAP 650-1000mg per dose has been shown to be more effective than Tramadol!
• Muscle relaxants: Little evidence of benefit, so need to do RvB analysis (Flexeril is most sedating)

Question 9

Anticonvulsants

Answer 9

Decreased bone density with chronic use (remember Ca+ supplements), dopaminergic agents can cause syncope; longer use of these drugs = incr falls risk

Question 10

Antihypertensive

Answer 10

Mainly Diuretics, BBlockers, Alpha blockers, vasodilators

Question 11

Hypoglycemic agents

Answer 11

o Avoid hypoglycemia
o Sulfonylureas are worst offender, avoid glyburide if possible
o Watch insulins and CBGs treat symptoms if stable, don’t check BG

Question 12

OTC

Answer 12

Benadryl, doxylamine, other antihistamines

Question 13

of meds

Answer 13

> 4-6 medications increases falls risk. - Complexity of regimens (multi-times per day) incr falls risk—more in self med or independent