Polypharmacy/Falls — RACP Adult Medicine MCQ

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ModerateGeriatric MedicinePolypharmacy/FallsRACP Adult Medicine

An 85-year-old man with dementia, recurrent falls, and faecal incontinence is admitted from a residential aged care facility. He is taking risperidone, oxybutynin, temazepam, and atorvastatin. His MMSE is 14/30 and he had 3 falls in the past month. Which medication should be prioritised for deprescribing?

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Correct answer: B — Temazepam

While multiple medications warrant review, temazepam (a benzodiazepine) is the highest priority for deprescribing given its strong association with falls, fractures, and worsening cognition in older adults. Australian Deprescribing Guidelines identify benzodiazepines as a priority for deprescribing in older adults. Oxybutynin (anticholinergic – cognitive impairment) and risperidone (falls, mortality in dementia) also warrant review, but benzodiazepines have the strongest evidence for harm from falls.

Reference: NHMRC/AMS – 2024 – Deprescribing Guidelines; Beers Criteria – 2023