Falls, polypharmacy and frailty in old-age psychiatry

Meet the patient

An 82-year-old woman in residential aged care is found on the floor at 3am, third time in six weeks. The incident form says mechanical fall, no injury, staff to increase supervision.^[10]

Her chart holds temazepam nightly for nine years, risperidone started four months ago for calling out, sertraline increased a fortnight ago, and oxybutynin nobody can account for. Her sodium has not been checked since the sertraline went up.^[4][5][7]

Two questions decide the whole answer. Which of these falls is the medication doing? And what do I stop first without destabilising her? Everything below exists to answer those two.^[5][13]

Etymology worth one line in a viva: iatrogenic is Greek — iatros (healer) plus genes (produced by). Literally: brought about by the doctor. Nowhere in medicine is the word more literal than a psychotropic fall, and nowhere is it more fixable.^[4][5][16]

References16ShowHide

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10. [10]Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons J Am Geriatr Soc, 2011.PMID 21226685
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