Elderly Falls/Medication Flashcards
What is syncope? What are causes and how does it overlap with falls in older people?
= sudden transient loss of consciousness due to reduced cerebral perfusion causing the patient to be unresponsive and lose postural control but with spontaneous recovery
Situational hypotension Vasovagal stimulation Cardiac arrhythmia/Ischaemia Pulmonary embolism TIA/Stroke
Falls are usually multifactorial
What are the major intrinsic causes of falls?
Syncope Dizziness Seizures Peripheral neuropathy Stroke Visual impairment Parkinson’s Side effects of drugs Cognitive impairment
What are the major extrinsic causes of falls in older people?
Poor lighting Clutter Inappropriate footwear Incorrect use of walking aids Pets/children Trailing cables Slippery floors Unfamiliar environment Toilet/bathroom problems
What does DAME stand for and when is it useful?
Outlines common causes of falls
Drugs - polypharmacy/alcohol
Age-related changes - gait, balance, sarcopenia, sensory impairment
Medical - syncope, PD, stroke
Environmental - obstacles, trailing wires, lighting
What does SPLATTD stand for and when is it used?
For conducting history to diagnose falls
Symptoms - dizziness, lightheaded, chest pain, palpitations, loss of consciousness
Previous falls?
Location - where did the fall happen?
Activity - what were they doing?
Time - soon after taking tablets? After meal? Associated with coughing?
Trauma - sustained? Injuries that need attention?
Drug history
What are the treatment options for falls in old people?
OT assessment to change adapt home environment
Individualised strength and balance training - physio
Home hazard assessment
Vision assessment
Medication review with modification/withdrawal
Management of causes and recognised risk factors
What is an adverse drug reaction?
Injury caused by taking a medication - an undesirable effect of a drug beyond its anticipated therapeutic effects occurring during clinical use
What factors contribute to adverse drug reactions?
Mainly polypharmacy and inappropriate prescribing
DoTS classification: Dose, Time-course, Susceptibility
What are the effects of dose-mediated ADRs?
Toxic reaction above the therapeutic range
Collateral reaction within the therapeutic range (eg drowsiness side effect)
Hypersusceptibility reaction below the therapeutic range (eg penicillin allergy)
What are different time-course ADRs?
First dose reactions (hypotension after first dose of ACEi) Early reactions (induced headache which wears off) Intermediate reactions (within a specific time frame) Late reactions (bruising) Withdrawal reactions (common with antidepressants) Delayed reactions (carcinogens/teratogens)
What are factors that would make some people more susceptible to ADRs?
Genetic susceptibility Age Sex Specific physiological states (pregnancy) Diseases (hepatic/renal impairment) Exogenous factors (drugs/diet)
Define ageing
Gradual loss of function of cells and organs, with the eventual outcome of death
What are the 4 pharmacokinetic phases and how are they altered in older people?
Absorption: swallowing, gastric emptying, intestinal motility, blood flow, surface area
Distribution: reduced tissue perfusion and blood flow, reduced plasma protein binding and volume of distribution
Metabolism: reduced hepatic mass, hepatic blood flow, thyroid function
Excretion: reduced renal blood flow and GFR increases excretion time - older patients take longer to eliminate
What are changes in homeostasis in older people and how do they affect pharmacology?
Reduced homeostatic functions = increased ADRs
Reduced baroreceptor reflex, postural control, thermoregulation, cognitive function, immune response
How does multi-morbidity influence ADRs in older people?
More drugs are needed = more interactions = increased risk of ADRs
Eg. Anticholinergic for BPH cause urinary retention and benzodiazepines precipitate delirium in dementia patients
