Management

Evidence has demonstrated that a multifactorial approach and intervention strategy is needed to reduce the rate of falling in older patients (Figure 4-3). Because one of the most modifiable risk factors is medication use, medication review is a key component of management (Hanlon et al., 1997). The review should focus on decreasing the dose or discontinuing sedating medications. If orthostasis is present, adjustment of diuretics and antihypertensive medications should be considered. The role of vitamin D in fall prevention is questionable. Although, it probably does not decrease the risk of falls, except in patients with low levels of vitamin D, supplementation should be started in patients with osteope-nia or osteoporosis (Gillespie et al., 2009).

Supervised exercise programs should be considered for patients at high risk for falls; exercise can reduce the physical risk factors (Rose, 2008). Specifically, programs that focus on two of three exercise components (strengthening, balance training, and aerobic/endurance training) for a minimum of 12 weeks have shown the most benefit (Costello and Edelstein, 2008). Finally, home hazard evaluation and intervention is an essential component in the assessment of falls in elderly

KEY TREATMENT

Risk factor assessment and multifactorial intervention reduces rate of falls (Gillespie et al., 2009) (SOR: A).

Exercise programs that target more than two components reduce rate of falls (Gillespie et al., 2009) (SOR: A). Community-living elderly patients who have fallen or who have risk factors for falling should have their homes assessed for safety (Gillespie et al., 2001) (SOR: A).

All older individuals should be asked at least once yearly about falls (Tinetti, 2003, AGS et al., 2001) (SOR: C).

persons, particularly those with visual impairment and multiple risk factors (Gillespie et al., 2001; Stevens et al., 2001).

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