Falls clinics reliably do the strength and balance work and reliably leave the drug chart alone, because the analgesia belongs to someone else and the patient is in pain. But an older person on a controlled analgesic is carrying a falls risk that no amount of quadriceps work fully offsets.
So make the medication count part of the falls assessment itself: list every drug acting on the central nervous system — opioids, gabapentinoids, benzodiazepines, z-drugs, tricyclics, antihistamines — and write the total down. A number in the notes is what makes the next review able to tell whether anything has changed.
Then tie the deprescribing to the programme rather than doing it separately. As pain and function improve over the first weeks, that is the window when a reduction is most likely to be accepted and least likely to fail — and, on today's evidence, the window in which it does most of the work.
- Count and record every centrally acting drug as part of the falls assessment
- Plan analgesic reduction to run alongside rehabilitation, not after it
- Reduce one drug at a time and review within weeks, not months
- Tell the patient the reduction is part of the falls plan, not a withdrawal of care
- Re-count at each review so the trajectory is visible
Why it matters
The falls intervention with the clearest mechanism is the one most falls clinics leave to someone else.
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