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Jun 13 2018 Falls in Older Adults Case

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ECHO Session 10 on Falls in Older Adults

Date:  June 13, 2018

PLEASE NOTE that Project ECHO® Care of the Elderly case recommendations do not create or otherwise    establish  a  provider-patient relationship between any   ECHO Care of the Elderly Hub team member/presenters and any patient whose case is being presented in a Project ECHO® setting.

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85yo man, hx of remote CVA with left hemiparesis, osteoarthritis, hypertension, BPH, multiple falls,  and intracerebral bleed 2016 from a fall. Family Hx of rheumatoid arthritis. Referred to our team from acute care after a fall with a bleed in 2016. Client was homebound, unable to get out to see their previous family doctor due to left side weakness/osteoarthritis/pain. He was taking no meds other than naproxen to manage pain, and his BP was quite elevated SBP 160-180/98.  Naproxen was stopped and he was put on acetaminophen and starting on perindropril.  Needless to say his pain worsened. Went back and forth with him until his current regimen, pain is much improved but he continues to fall, will find bruising and abrasions, and when asked he states he tripped or he forgot his walker etc.  We feel he would be better supported in a LTC home environment but pt is adamant to stay home.


  1. Consider pacing the rate at which suggestions are made
  2. Consider doing GGT to see if alcohol is playing a bigger role. Perhaps might be a factor to motivate reduced alcohol intake.
  3. Consider marking the bottles he drinks alcohol from to understand how much he is consuming. With his agreement only, as a tool to help him appreciate how much he is drinking (cognitive impairment may have a role).
  4. Consider using Motivational interviewing techniques to explain how drinking may affect his sleep and support his efforts to be in concordance with recommendations
  5. Considering finding out more about history of falls to target interventions
  6. Consider exercises – focus on balance and strength. Could PSW assist with exercises on daily visits?
  7. See if there is funding for personal safety device
  8. Considering having him see a dietitian
  9. Consider accessing going to wheel trans to activities he enjoys
  10. Look into veterans centre to see if he eligible to join
  11. Consider 24 hour monitoring of BP and heart rhythm (Holter)
  12. Consider finding out if there is an inflammatory component to joint pain and morning stiffness, given joint effusion, response to NSAID and family history, and if NSAID/DMARD appropriate
  13. Consider increasing duloxetine from 30 to 60 mg, and then reducing mirtazapine