#1: Geriatric Falls & Assessment with Dr. Lisa Miura
Which medications should I stop to prevent my patient' falls? What's the deal with Vitamin D and falls? And what matters most to Geriatricians? On this, the FIRST episode of VeriGeri, we speak with Dr. Lisa Miura, Geriatrician, Associate Professor of Medicine, and fall expert at Oregon Health and Science University to answer these questions and more. Hear Dr. Miura carefully walk us through a new patient fall assessment- including what physical exam maneuvers, labs, and imaging she utilizes to understand the story behind the fall. She teaches us all about identifying and reducing patients' modifiable risk factors for falls, as well as simple interventions that go a long way in fall prevention. Show notes: Falls with Dr. Miura (verigeripodcast.com) 0:00 Intro 1:53 This episode's Guru, Dr. Lisa Miura 3:22 The Case! 3:48 Questions to ask 4:46 Conditions of the fall 5:17 Definition of a fall 7:16 Chart review approach 8:50 How to maximize time in a visit 9:09 Relationship between falls and cognitive decline, mood 10:24 The interesting medication list 11:11 The rest of the patient encounter, including social history and physical exam 12:00 Dr. Miura's approach 12:12 Addressing polypharmacy 13:42 Gabapentin 14:59 Styles in making medication changes 16:59 Cognitive workup 17:24 Sensory impairments 17:45 Urinary symptoms 18:05 Blood tests for neuropathy 18:32 Social history clarification 19:06 Things to care about in the home environment 19:34 Footwear 19:55 Exercise 21:00 Physical Exam 25:40 Labs & imaging 27:12 Vitamin D 29:06 Assessment and Plan 33:50 Outro Hosts: Patty Lee, Sam Ing, Marissa Korte Guru: Dr. Lisa Miura Case writers: Patty Lee, Sam Ing with edits from Dr. Lisa Miura