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Geriatrics > Falls + Frailty > Flashcards

Falls + Frailty Flashcards

1
Q

WHO defines a fall as an event…

A

Which results in a person coming to rest inadvertently on the ground, or other lower level

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2
Q

Falls contribute for ____ in older adults

A

Primary mechanism of injury causing death
#1 cause of traumatic hospitalizations/non-fatal injuries

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3
Q

____ % of falls result in serious injury, such as…

A

5-10% - bone fractures, head injury, laceration

Hip fractures !

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4
Q

Fear of falling syndrome is…

A

When individuals restrict their activities due to fear of falling - activity avoidance, deconditioning, increased fall risk

Social isolation, low mood, decreased QoL

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5
Q

Medical/biological risk factors for falls include…

A

Deconditioning
Vision/hearing impairment
Orthostatic hypotension, dizziness, syncope
HR/rhythm abnormalities
Pain, neuropathy

Other medical conditions

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6
Q

Environmental risk factors for falls include…

A

Home hazards - clutter, pets, rugs, lighting

Community hazards - ice, uneven pavement, curbs, slippery floors, tripping hazards

Lack of familiarity with surroundings

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7
Q

Social/economic risk factors for falls includes…

A

Social isolation
Living alone, lack of community/family supports
Lack of transportation
Low income

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8
Q

Behavioural risk factors for falls include…

A

Alcohol use
Impulsivity/risk-taking, rushing
Fear of falling
Lacking assistive devices

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9
Q

Drugs may contribute to falls in various ways, such as…

A

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)

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10
Q

Benzodiazepines may increase fall-risk via…

A

Cognitive changes/confusion
Drowsiness, dizziness
Muscle weakness, decrease balance + coordination

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11
Q

Antipsychotics may increase fall-risk via…

A

Increased risk of mvmt disorders (EPS)
Orthostatic hypotension
Sedation

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12
Q

Antidepressants may increase fall-risk via…

A

Sedation
Some of them are anticholinergic

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13
Q

A class of medications we are especially concerned with, for fall-risk is…

A

Anticholinergic

Sedation, blurred vision, cognitive changes

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14
Q

Examples of drugs with severe anticholinergic burden included…

A

Chlorphenamine
Clemastine
TCA’s

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15
Q

CV medications may increase fall-risk by…

A

Antiarrhythmics - affect heart rate, increased risk
Risk of orthostatic hypotension

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16
Q

Hypoglycemics has been associated with…

A

Severely increased fall risk - insulin also associated with fall risk

17
Q

Anticonvulsants may contribute to fall risk via…

A

Sedation, dizziness
CNS; cognitive changes

18
Q

Opioids have shown mixed results for fall risk, because…

A

Increase fall risk if cognitive effect
Decreased fall risk if pain treatment is effective

19
Q

Multifactorial fall risk assessment is recommended for…

A

Individuals that have fallen 2+ times in the past 12 months
After an acute fall
Gait or balance difficulties

20
Q

Pharmacists can participate in multifactorial interventions for fall prevention by…

A

Ensuring clinical disease management is complete
Medication review + modification

21
Q

Evidence of vitamin D + fall prevention is…

A

Mixed: some studies + meta-analysis have shown decreased fall risk with vitamin D supplementation

22
Q

Frailty is a medical syndrome that…

A

Increases an individual’s vulnerability to loss of independence and/or death

Decreased strength, endurance, functional reserve - increased vulnerability to stressors

23
Q

The best single-item predictor for frailty is…

A

Gait speed - predicts functional decline and mortality

<0.8 m/s correlates with frailty

24
Q

Examples of medication AE’s contributing to frailty include…

A

Nausea/GI upset = decreased appetite and weight loss

Fatigue = decreased activity, deconditioning

25
Q

Medications and increased frailty is associated with…

A

Increased risk of adverse drug reactions (primarily for those on 5+ medications)

26
Q

Frailty has also emerged as an important consideration when evaluating the appropriateness of certain interventions in guidelines. An example of this is…

A

Diabetes Canada guidelines specifying more lenient glycemic targets for frail older adults

27
Q

We need to consider impact of medications on an individuals ability to…

A

Function - discussing benefits and risks of a medication with the patient

28
Q

Multifactorial approaches of frailty management include…

A

Comprehensive geriatric assessment
Exercise programs
Optimizing health status
Streamlining medications as much as possible

29
Q

Polypharmacy + Geriatric syndromes are associated with…

A

Falls
Cognitive Impairment
Lower functional status
Malnutrition

Geriatrics (12 decks)

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