Falls

Question 1

physiologic changes with aging that can contribute to falls

Answer 1

↓ lean body mass, ↓ CO, ↓ pulmonary function, ↓ accommodation of the lens of the eye, ↓ skeletal bone mass (osteopenia), alterations in cognition

Question 2

intrinsic (non-modifiable) risk factors of falls

Answer 2

muscle weakness, impaired balance & mobility, comorbidities: arthritis, stroke, diabetes, HTN, heart disease and dementia

Question 3

extrinsic (modifiable) risk factors for falls

Answer 3

medication use*, poor foot care, unsafe footwear, impaired vision, hearing problems, unsafe environment

Question 4

consequences of falls

Answer 4

fear of falling, loss of confidence & mobility, admission to the hospital, institutional relocation (9-27%)
*95% of all hip injuries occur from falls

Question 5

diazepam and falls

Answer 5

doses >/ 3mg/day of diazepam ↑ risk of hip fracture by 50%

Question 6

benzos and hip fractures

Answer 6

60% ↑ in falls in first 2 weeks, 80% ↑ after continuous 1 month

Question 7

possible FRIDs (fall risk increasing drug)

Answer 7

statins, PPIs

Question 8

drug burden index (DBI) definition

Answer 8

a method for measuring total exposure to anticholinergic and sedative drugs

Question 9

medications that influence falls in elderly

Answer 9

antihypertensives, diuretics, B-blockers, sedative-hypnotics, antipsychotics, antidepressants, benzos, narcotics, NSAIDs

Question 10

barriers to preventing falls

Answer 10

lack of knowledge, geographic barriers, incomplete adoption of behaviors, lack of organization and financial support, lack of coordination among providers

Question 11

interventions for preventing falls

Answer 11

multifactorial interventions and gradual withdrawals of psychotropic medications reduced rate of falls but not risk of falling

Question 12

*falls free: national falls prevention action plan

Answer 12

physical mobility, medication management, home safety, environmental safety in the community

Question 13

medications management goal A

Answer 13

all older adults are aware that falling is a common ADE of some medications and discuss these effects with their health care provider

Question 14

strategies to support goal A

Answer 14

↑ the number of adults who have a medication review by a pharmacist annually and focus on fall prevention

Question 15

medications management goal B

Answer 15

healthcare providers will be aware that falling is a common ADE of medications and will adopt a standard of care that balances harm and benefit of meds in older adults

Question 16

strategies to support goal B

Answer 16

medication therapy management services and systems that predict how various combos of meds interact and increase risk of falls

Question 17

STEADI-Rx

Answer 17

community pharmacy fall risk checklist

Question 18

AHRQ

Answer 18

preventing falls in hospitals, >/6=high risk (multiply by how many meds)
3=analgesics, antipsychotics, anticonvulsants, benzos
2=antihypertensives, cardiac drugs, antiarrhythmics, antidepressants
1=diuretics

Question 19

world guidelines for high risk

Answer 19

worries about falling, feeling unsteady, or a fall in the past year PLUS injury from fall, frailty, inability to get back up, loss of consciousness from fall

Question 20

if world guidelines deems high risk

Answer 20

multifactorial assessment: review meds for FRIDS using tools, appropriate deprescribing, follow up in 30-90 days

Question 21

STOPPFall medications

Answer 21

BZDs, antipsychotics, opioids, antidepressants, anti epileptics, diuretics, alpha blockers, antihypertensives, antihistamines, vasodilators