A frail, 93-year-old woman with mild dementia enters a nursing home due to difficulty managing on her own. She has recently had several falls, including one during the night while getting out of bed to use the bathroom. The patient attributes this fall to "clumsiness." Syncope workup is unremarkable for any abnormalities. She has a medical history of hypertension, osteoarthritis, depression, and anxiety. Her medications include amlodipine, sertraline, aripiprazole, and amitriptyline. Which of the following is the most effective strategy for decreasing this patient's fall risk?

Question

A frail, 93-year-old woman with mild dementia enters a nursing home due to difficulty managing on her own.  She has recently had several falls, including one during the night while getting out of bed to use the bathroom.  The patient attributes this fall to "clumsiness."  Syncope workup is unremarkable for any abnormalities.  She has a medical history of hypertension, osteoarthritis, depression, and anxiety.  Her medications include amlodipine, sertraline, aripiprazole, and amitriptyline.  Which of the following is the most effective strategy for decreasing this patient's fall risk?

Quizplus · Accepted Answer

This patient has multiple risk factors for falls, including advanced age, arthritis, prior history of falls, cognitive impairment, and use of multiple medications associated with increased risk of falling (ie, psychotropic and cardiovascular drugs). Medication use is one of the most modifiable risk factors for falls. Psychotropic drugs, including antipsychotics such as aripiprazole; antidepressants, such as sertraline and amitriptyline; and benzodiazepines are most commonly associated with increased fall risk. Cardiovascular drugs that reduce circulating blood volume or blood pressure such as calcium channel blockers (eg, amlodipine), beta blockers, and diuretics are also associated with falls. The patient should undergo a medication review with the goal of finding the lowest effective dose, eliminating unnecessary medications, and/or switching to those associated with a lower fall risk. (Choices A and D) Bed rails and soft physical restraints have not been shown to reduce falls in long-term care facilities. Some studies indicate a slightly increased risk of falls and injury in nursing home patients who are physically restrained. (Choices B and E) Assistive devices such as canes and walkers are often used to improve mobility in patients with gait or balance disturbances. However, there is a lack of evidence regarding their efficacy in preventing falls (they may impair compensatory stepping reactions that help with balance recovery). Educational objective: Falls are a common problem in elderly nursing home patients. Optimal management includes a careful medication review with the goal of limiting the use of agents associated with increased fall risk. __________ References: Medication-related falls in the elderly: causative factors and preventive strategies. (http://www.ncbi.nlm.nih.gov/pubmed/22550966) Medication-related falls in the elderly: mechanisms and prevention strategies. (http://www.ncbi.nlm.nih.gov/pubmed/25202895)

A Frail, 93-Year-Old Woman with Mild Dementia Enters a Nursing