There is no specific intervention that would be beneficial in this older patient with cognitive impairment; therefore, continuing this patient's current care is appropriate. In older adults, falls are a source of morbidity, mortality, decreased functionality, and premature institutionalization. Risk factors for falling are myriad and include lower extremity weakness, history of falls, gait or balance deficits, polypharmacy, low vitamin D level, visual impairments, and cognitive impairment. Many risk factors are amenable to remediation; however, there is insufficient evidence to support any specific interventions to reduce fall risk in the cognitively impaired beyond those risk factors that can be treated. This patient is under close supervision and well cared for by her family, and she has no clearly reversible risk factors. Therefore, it is reasonable to continue her current care provided by her family.

Although individualized exercise programs to decrease falls have been shown to be effective in cognitively intact, community-dwelling adults, such exercise programs have not been shown to benefit cognitively impaired individuals. The lack of benefit is speculated to be caused by the cognitively impaired patient's inability to retain and incorporate instructions over time.

Antipsychotic medications, such as risperidone, have not been shown to reduce falls in patients with cognitive deficits. Furthermore, risperidone may induce orthostatic hypotension, which may actually increase this patient's risk of falling.

Although many patients are placed in skilled nursing facilities due to falls, there is no evidence that care in a skilled nursing facility is more likely to reduce falls than conscientious care in the home. This is particularly true in this case in which the patient's daughter is clearly meticulous in the care she provides.