AN INTERDISCIPLINARY APPROACH TO OLDER ADULT FALL PREVENTION April 15, 2015 Sponsored by The Geriatrics and Gerontology Education and Research Program, University of Maryland, Baltimore The Johns Hopkins Geriatric Education Center Consortium The Center for Injury and Sexual Assault Prevention, Department of Health and Mental Hygiene

Presentations The Essentials of Preventing Falls in the Older Adult Jessica Colburn, MD, The Johns Hopkins School of Medicine and Hopkins Bayview Medical Center Falls Management in Older Adults: “The Double-Edged Sword” Dennis Klima, PT PhD GCS NCS, University of Maryland Eastern Shore Preventing Medication-Related Falls through Appropriate Medication Use Chanel Agness, PharmD, BCPS, CGP, FASCP and Stephanie Callinan, PharmD University of Maryland School of Pharmacy

Case Discussion History of Present Illness: Mr. Samuel is a 84 year old man who was recently admitted to Sunnyside Nursing Facility after a recent hospitalization due to dehydration. Patient was started on amlodipine, pantoprazole and zolpidem during hospitalization. Patient complains of dizziness and lightheadedness when getting up from a seated position. Also reports that he gets up twice a night to use the bathroom. His Timed Up and Go (TUG) Score is 19 seconds. He tends to shuffle his feet in gait. He complains of hip pain and weakness.

Case Discussion He had a prior fall at home this past year and was instructed to use a cane. He lives in a 3 story row home in East Baltimore with his wife. His wife has what he describes as some “forgetfulness”. He has a small dog that he loves to walk in neighborhood. His goal is to return home.

Past Medical History : Hypertension Osteoarthritis Benign Prostatic Hypertrophy Diabetes

Medications: Aspirin 81 mg daily Sliding Scale Insulin Atenolol 100 mg twice daily Oxycodone/Acetaminophen 5/325 mg three times daily Terazosin 1 mg nightly at bedtime Zolpidem 10mg at bedtime Chlorpheniramine for occasional allergies

Vital Signs: (as found in chart) Sitting BP: 146/84 mmHg, pulse 76 Standing BP: 130/70 mmHg, pulse 88

Questions Using Beer’s List, identify potentially inappropriate medications that can increase risk for falls. Using 31 Tool, assess Mr. Samuel’s medication –related fall risk. Recommend one strategy to decrease medication –related fall risk AND to educate Mr. Samuel. What is potentially one intrinsic cause of falls which pertains to his medical history and gait? What are some potential extrinsic risk factors that need to be considered for him to go home?

Questions What are some potential mobility interventions to decrease his fall risk? What should we do about assessing for his vitamin D.