Elderly/Falls Flashcards
What are common symptoms associated with late stage of dying?
Pain Breathlessness Agitation / restlessness Increased respiratory secretions Drowsiness Diminished oral intake Profound weakness Skin colour changes Urinary incontinence Faecal incontinence
What are key principles of a palliative care approach?
Symptom control
Relief of distress
Care for the family
Medicines prescribed only for relief of symptoms
Stopping of curative medication
Fluids unnecessary and can worsen bronchial secretions
Why are older people more likely to fall?
Musculoskeletal:
Muscle weakness, OA, joint deformities, injuries
Neurological:
Cognitive function, lower limb peripheral nerves, proprioception, reflexes, cortical, extrapyramidal and cortical function. fewer neurones, nerve fibres and slower reaction times
Vision:
Reduced acuity, dark adaption, contrast sensitivity
Cardiovascular:
heart rate and rhythm, postural blood pressure, heart failure, heart murmur.
Vestibular System:
Reduced hair cells and nerve fibres and reflexes slower and less accurate
What are the reflexes in balance?
Vestibulo-optic reflex - maintains visual fixation
Vestibulo-spinal reflex - keeps head level when spine moving
What are no-cost strategies in improving risk of falls?
Sitting to dress
Different ways of doing an activity
Moving furniture to aid mobility and maximise safety
Moving frequently used items in the house to be more accessible
Carrying phone if need to call for help
Who are classed as high risk fallers?
Fallen before in previous 12 months Fall with injury Cognitive impairment Visual impairment Gait or balance impairment Fear of falling Leaving a rehab setting particularly neck of femur fracture
What is the purpose of home assessment?
Identify home hazards and recommend or arrange modifications
Assess and modify performance and function
Identify and agree strategies to reduce falls risk
Education and information giving
What is the definition of frailty and what are features?
A syndrome that combines the effects of natural ageing with the outcomes of multiple long term conditions, a loss of fitness and reserves.
- Older people with one or more chronic, long-term conditions such as heart disease or COPD
- Older people who may not have a specific diagnosed condition but still require support from care services in order to live independently.
Delirium Falls Immobility Continence problems Medicines management challenges
What are advantages of hospital admission?
- Regular mealtimes
- Relieving strain on family members
- Assistance with daily activities
- Healthcare services on hand
- Safety
What are disadvantages of hospital admission?
- Risk of deterioration
- Highest readmission rate
- Reduction in their ability to undertake activities of daily living
- Deterioration in their balance and mobility
- Increase risk of death
- Infections in hospital
- Loneliness and isolation
What are physical signs of death?
- No spontaneous movements
- No respiratory effort - examine for 1 minute
- No heart sounds - examine for 1 minute
- No palpable pulses - examine for 1 minute
- No response to pain stimuli
- Absence of reflexes
- Pupils are fixed and dilated
- Retinal vessels show coagulation
What are advantages of admission to a hospice?
- Provides pain control
- Provides care needs
- Caters for drug administration needs
- Relief for carers
- Patients wishes
- Limiting emotional stress for children and relatives
What are physiological changes in elderly?
Changes in body composition with loss of lean body mass
Loss of muscle strength and poor balance
Decline in renal function
Changes in metabolism of drugs cleared by liver
What are problems with the side effects of drugs at end of life?
Sedation - taking away social interaction
Respiratory depression
Drying - distressing to patient, unable to communicate
Confusion/amnesia - taking away social interaction
What are measures of minimising drug interactions in elderly patients?
Get an accurate drug history including details on reasons why a patient is taking a particular medication, and whether they still need it or not
Give priority to non-drug alternatives e.g. information, advice, psychological or mechanical therapies, lifestyle change
Ask the patients if they have noticed any adverse or side effects
Use lowest possible dose that provides benefit for shortest required duration
Recognize mechanisms of action for the drugs, and check BNF for advice regarding drugs that have narrow therapeutic range or have high risk of serious adverse effects
Put in place dose adjustment or choose different dosing regimen if pharmacokinetic interaction is predicted
Close monitoring for patients considered to be at risk, this includes drug levels, or haematology/biochemistry blood tests
Check with pharmacist regarding medicines information
