Risk factors
- 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
Medical conditions
- 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)
Antidepressants
TCAs and SSRI (Paroxetine is the worse)
Benzos
- 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
Sedative/hypnotics
- Zolpidem has anesthetic effects, incr falls risk
- All can impact balance, gait, and equilibrium
Antipsychotics
First gen worse, but both are associated with falls
Anticholinergic
- Incontinence: Oxybutynin is the worst offender
- Depression (see above)
- Parkinson’s Disease (PD): Benztropine and trihexyphenidyl
Pain Therapy
- 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)
Anticonvulsants
Decreased bone density with chronic use (remember Ca+ supplements), dopaminergic agents can cause syncope; longer use of these drugs = incr falls risk
Antihypertensive
Mainly Diuretics, BBlockers, Alpha blockers, vasodilators
Hypoglycemic agents
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
OTC
Benadryl, doxylamine, other antihistamines
of meds
> 4-6 medications increases falls risk. - Complexity of regimens (multi-times per day) incr falls risk—more in self med or independent
