Mobility and Assistive Devices

Benzodiazepines and other drugs that act on the central nervous system increase the risk of falls. In a meta-analysis of 22 studies, the odds of falling was increased 1.5 times with use of benzodiazepines. Additionally, a placebo-controlled trial found that gradual withdrawal of psychotropic medications reduced the rate of falls. Cognitive-behavioral therapy to address fear of falling was not shown to reduce rate of falls or risk of falling in a meta-analysis of 3 trials. Impaired vision is associated with falls and hip fracture, and correction of visual impairment in combination with exercise and environmental modifications has been shown to reduce injurious falls. However, multifocal lenses may impair contrast sensitivity and depth perception; they have been associated with an increased risk of falls. In a prospective cohort study, wearers of multifocal glasses were more likely to fall because of a trip, when outside their homes, and when walking up or down stairs. Because this patient’s visual acuity is impaired (20/40 in both eyes), it would be appropriate to refer him to an ophthalmologist for further evaluation. Low beds have not been shown to reduce the risk of falls. A single, cluster-randomized trial of low beds in 18 hospital wards, including 22,036 participants, found no significant reduction in frequency of patient injuries or falls. Rising from a low bed may also be difficult for an older adult, potentially hindering mobility.