Reducing fall risk while managing hypotension, pain, and poor sleep in an 83-year-old woman.

While medications might not be the sole contributor to fall risk, they are often a modifiable risk factor. Pain, which also affects mood, mobility, and sleep, can be successfully managed to reduce fall risk with the use of effective analgesics. Patients are often referred to the Bruyère Continuing Care Geriatric Day Hospital (GDH) in Ottawa, Ont, for management of these and other conditions over a 10to 12-week admission period. During this time, medication review focuses on reduction of polypharmacy while maximizing effective therapy and minimizing medications that contribute to symptoms or that are no longer required. This case illustrates how various cardiovascular therapies (eg, β-blockers, calcium channel blockers, loop diuretics) can contribute to dizziness, orthostatic hypotension, and subsequent falls in elderly patients. We describe how some of these medications were successfully tapered and discontinued with beneficial patient outcomes. Management of chronic pain is illustrated along with subsequent effects on mood, effects on sleep, and reduction in sedative use. Finally, the case demonstrates how 2 common undertreated conditions, anemia and low vitamin D levels, can contribute to falls.