Questions: Scenario: A 79-year-old female with a history of falls is currently taking a TCA. What does the AGS Beers Criteria suggest about the use of TCAs in this population? TCAs are appropriate with monitoring TCAs should be avoided due to fall risk TCAs are the first-line treatment for depression TCAs can be used in combination with benzodiazepines

The answer is the second one: TCAs should be avoided due to fall risk.

Explanation for each option:

1. TCAs are appropriate with monitoring: This option is incorrect. While monitoring is important for any medication, the AGS Beers Criteria specifically advises against the use of TCAs in older adults due to their side effects, including an increased risk of falls.

2. TCAs should be avoided due to fall risk: This option is correct. The AGS Beers Criteria recommends avoiding tricyclic antidepressants (TCAs) in older adults, especially those with a history of falls, because TCAs can cause sedation, orthostatic hypotension, and other side effects that increase the risk of falls.

3. TCAs are the first-line treatment for depression: This option is incorrect. TCAs are not considered the first-line treatment for depression in older adults due to their side effect profile and the availability of safer alternatives, such as SSRIs.

4. TCAs can be used in combination with benzodiazepines: This option is incorrect. Combining TCAs with benzodiazepines can further increase the risk of sedation and falls, making this combination particularly risky for older adults.

In summary, the AGS Beers Criteria suggests that TCAs should be avoided in older adults due to the increased risk of falls.