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Comment & Response
October 19, 2020

Anticoagulation Therapy and Fall Reduction

Author Affiliations
  • 1Department of Geriatric Medicine, St Vincent’s University Hospital, Dublin, Ireland
JAMA Intern Med. 2021;181(1):142. doi:10.1001/jamainternmed.2020.5418

To the Editor In their Teachable Moment, Edward and Gopal1 describe an important case in which unnecessary use of aspirin in addition to anticoagulation therapy likely caused a greater degree of injury than may have otherwise occurred to a man who had 2 mechanical falls as well as 3 prior falls. I would like to add 2 points to the discussion.

First, mechanical fall is an unclear, inconsistently used term that is best avoided.2 It is commonly used to describe a fall for which no acute cardiovascular cause was found and for which environmental factors are suspected. However, these are seldom the only reasons for an older adult to fall, and underlying issues such as comorbidity or frailty are relevant. Using the label mechanical may risk the misapprehension that there is no indication for further assessment and investigation. This man had an apparently unidentified reason for his 5 falls occurring within a year.

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