Falls + Frailty Flashcards
WHO defines a fall as an event…
Which results in a person coming to rest inadvertently on the ground, or other lower level
Falls contribute for ____ in older adults
Primary mechanism of injury causing death
#1 cause of traumatic hospitalizations/non-fatal injuries
____ % of falls result in serious injury, such as…
5-10% - bone fractures, head injury, laceration
Hip fractures !
Fear of falling syndrome is…
When individuals restrict their activities due to fear of falling - activity avoidance, deconditioning, increased fall risk
Social isolation, low mood, decreased QoL
Medical/biological risk factors for falls include…
Deconditioning
Vision/hearing impairment
Orthostatic hypotension, dizziness, syncope
HR/rhythm abnormalities
Pain, neuropathy
Other medical conditions
Environmental risk factors for falls include…
Home hazards - clutter, pets, rugs, lighting
Community hazards - ice, uneven pavement, curbs, slippery floors, tripping hazards
Lack of familiarity with surroundings
Social/economic risk factors for falls includes…
Social isolation
Living alone, lack of community/family supports
Lack of transportation
Low income
Behavioural risk factors for falls include…
Alcohol use
Impulsivity/risk-taking, rushing
Fear of falling
Lacking assistive devices
Drugs may contribute to falls in various ways, such as…
Cognitive changes
Mvmt disorders, gait/balance changes
Muscle weakness
Dizziness, drowsiness
Vision changes
Indirect: diuretic = urinary urgency
Absence of appropriate drug tx also increases fall risk (pain, COPD)
Benzodiazepines may increase fall-risk via…
Cognitive changes/confusion
Drowsiness, dizziness
Muscle weakness, decrease balance + coordination
Antipsychotics may increase fall-risk via…
Increased risk of mvmt disorders (EPS)
Orthostatic hypotension
Sedation
Antidepressants may increase fall-risk via…
Sedation
Some of them are anticholinergic
A class of medications we are especially concerned with, for fall-risk is…
Anticholinergic
Sedation, blurred vision, cognitive changes
Examples of drugs with severe anticholinergic burden included…
Chlorphenamine
Clemastine
TCA’s
CV medications may increase fall-risk by…
Antiarrhythmics - affect heart rate, increased risk
Risk of orthostatic hypotension
Hypoglycemics has been associated with…
Severely increased fall risk - insulin also associated with fall risk
Anticonvulsants may contribute to fall risk via…
Sedation, dizziness
CNS; cognitive changes
Opioids have shown mixed results for fall risk, because…
Increase fall risk if cognitive effect
Decreased fall risk if pain treatment is effective
Multifactorial fall risk assessment is recommended for…
Individuals that have fallen 2+ times in the past 12 months
After an acute fall
Gait or balance difficulties
Pharmacists can participate in multifactorial interventions for fall prevention by…
Ensuring clinical disease management is complete
Medication review + modification
Evidence of vitamin D + fall prevention is…
Mixed: some studies + meta-analysis have shown decreased fall risk with vitamin D supplementation
Frailty is a medical syndrome that…
Increases an individual’s vulnerability to loss of independence and/or death
Decreased strength, endurance, functional reserve - increased vulnerability to stressors
The best single-item predictor for frailty is…
Gait speed - predicts functional decline and mortality
<0.8 m/s correlates with frailty
Examples of medication AE’s contributing to frailty include…
Nausea/GI upset = decreased appetite and weight loss
Fatigue = decreased activity, deconditioning
Medications and increased frailty is associated with…
Increased risk of adverse drug reactions (primarily for those on 5+ medications)
Frailty has also emerged as an important consideration when evaluating the appropriateness of certain interventions in guidelines. An example of this is…
Diabetes Canada guidelines specifying more lenient glycemic targets for frail older adults
We need to consider impact of medications on an individuals ability to…
Function - discussing benefits and risks of a medication with the patient
Multifactorial approaches of frailty management include…
Comprehensive geriatric assessment
Exercise programs
Optimizing health status
Streamlining medications as much as possible
Polypharmacy + Geriatric syndromes are associated with…
Falls
Cognitive Impairment
Lower functional status
Malnutrition
