What is the best approach to prevent future falls in a 75-year-old woman with a history of falls, taking amlodipine for osteoarthritis and topical caps for knee pain?

Fall Prevention for a 75-Year-Old Woman with History of Falls

Tai Chi program is the most effective intervention for preventing future falls in this 75-year-old woman with a history of falls.1

Assessment of the Patient's Fall Risk Factors

This 75-year-old woman has several important risk factors for falls:

• History of a fall 6 months ago (strongest predictor of future falls)
• Advanced age (75 years)
• Medication use (amlodipine)
• Osteoarthritis affecting mobility

Evidence-Based Intervention Options

Tai Chi Program

• The USPSTF concludes with moderate certainty that exercise interventions provide moderate net benefit in preventing falls in older adults at increased risk 1
• Tai Chi specifically has been shown to reduce the risk of falling by 29% (RR 0.71,95% CI 0.57 to 0.87) 1, 2
• A randomized controlled trial demonstrated that a three-times-per-week, 6-month Tai Chi program effectively decreased the number of falls by 48% compared to stretching exercises 3
• A recent 2024 study showed a significant 32.3% reduction in falls (P=.001) among long-term care residents participating in a Tai Chi program 4

Vitamin D Supplementation

• The USPSTF concludes with moderate certainty that vitamin D supplementation has no net benefit in preventing falls in older adults 1
• While earlier evidence suggested vitamin D might reduce falls by approximately 17%, the most recent guidelines give it a D recommendation (no benefit) 1

Medication Management (Discontinuation of Amlodipine)

• While medication review is important, the American Geriatrics Society suggests focusing particularly on psychotropic medications rather than well-tolerated antihypertensives in the absence of orthostatic hypotension 1
• Amlodipine is not typically considered a high-risk medication for falls unless causing orthostatic hypotension
• No evidence suggests that discontinuing amlodipine alone would significantly reduce fall risk in this patient

No Further Intervention

• Given the patient's history of falls, this approach would leave her at continued high risk for future falls
• This option contradicts evidence-based guidelines that recommend active interventions for fall prevention in high-risk individuals 1

Implementation of Tai Chi Program

For optimal results, the Tai Chi program should:

• Be taught by qualified instructors 1
• Include at least 3 hours weekly of balance and functional exercises 1
• Continue for at least 10-12 weeks 1
• Focus on movements that improve balance and lower extremity strength 1

Additional Considerations

While Tai Chi is the primary recommendation, a comprehensive approach could also include:

1. Environmental assessment: Remove tripping hazards, improve lighting, and install handrails as needed 1

2. Medication review: While not discontinuing amlodipine, ensure her medications are not causing side effects that increase fall risk 1

3. Regular reassessment: Monitor progress and adjust interventions as needed 1

Potential Limitations and Considerations

• Patient adherence to the Tai Chi program is essential for effectiveness
• Some studies have shown mixed results with Tai Chi in certain populations 5, but the preponderance of evidence supports its use 1, 2, 3, 4
• The patient's knee pain from osteoarthritis should be monitored during exercise, with modifications made as needed

Tai Chi represents the most evidence-based choice among the options presented for this 75-year-old woman with a history of falls who wishes to prevent future falls.