Falls in the Elderly

Question 1

Three sensory systems that help us maintain our balance

Answer 1

• Peripheral vision
• Inner eat
• Stretch receptors in Achilles tendon
• Cerebellum processes all these signals, and tries to sort out if we are in balance, and what to do in order to correct our balance

Question 2

Peripheral vision

Answer 2

shows the horizon moving as our head moves through space

Question 3

Inner eat

Answer 3

• aka semicircular canals

- have fluid that accelerates as our head changes its aspect to gravity

Question 4

Stretch receptors in Achilles tendon

Answer 4

• activated as our body sways

- if we’re walking, as the foot strikes, the tendons stretch differently and we infer that we are off-center

Question 5

Of the three sensory systems that help us maintain our balance, which one is the strongest?

Answer 5

semicircular canals

Question 6

drugs that can impair our balance by reducing or confusing sensory input or processing

Answer 6

• glaucoma medications
• opioids
• anticonvulsants
• chemotherapeutic agents

Question 7

drugs that can impair our balance by reducing or confusing sensory input or processing: glaucoma medications

Answer 7

pilocarpine and other cholinergics (9 other drugs; probably all you would see used are Neostigmine, bethanechol)

Question 8

drugs that can impair our balance by reducing or confusing sensory input or processing: anticonvulsants

Answer 8

anticonvulsant toxicities are reflected in vestibular dysfunction: nystagmus, vertigo, ataxic gait

Question 9

drugs that can impair our balance by reducing or confusing sensory input or processing: chemotherapeutic agents

Answer 9

associated with neuropathy and messes with proprioception

Question 10

What is the correct height for a walker?

Answer 10

the user needs to bend at the hips in order to get the palms resting on the grips

Question 11

Drugs that slow reflexes

Answer 11

• Opioids
• Benzodiazepines, sedatives
• Antipsychotics
• Tricyclic and heterocyclic antidepressants
• Beta-blockers (probably not to an important degree)[propranolol]
• anticonvulsants
• Alcohol

Question 12

How can psychotropics cause falls?

Answer 12

associated with impaired postural control, more pronounced in patients of higher age, at higher daily doses, drugs with longer half-lives and administered over a longer period of time

Question 13

Identify drugs that can possibly cause falls

Answer 13

• Psychotropics
• Parkinson drugs
• Dementia treatments
• Anticonvulsatns
• Cholinergics
• Mineralocorticoids
• Diabetes drugs
• Urinary urgency drugs

Question 14

Identify drugs that can possibly cause falls

Answer 14

• Psychotropics
• Parkinson drugs
• Dementia treatments
• Anticonvulsatns
• Cholinergics
• Mineralocorticoids
• Diabetes drugs
• Urinary urgency drugs

Question 15

How can Parkinson drugs cause falls?

Answer 15

slow reflexes

Question 16

How can Dementia drugs cause falls?

Answer 16

patients not paying attention

Question 17

How can anticonvulsants cause falls?

Answer 17

seizure while standing (special kind of fall)

Question 18

How can cholinergic drugs cause falls?

Answer 18

impaired peripheral vision from glaucoma

Question 19

How can Mineralocorticoids cause falls?

Answer 19

treating orthostatic hypotension (?)

Question 20

How can Diabetes drugs cause falls?

Answer 20

neuropathy and impaired balance, impaired vision, hypoglycemia

Question 21

How can urinary urgency drugs cause falls?

Answer 21

rushing to the bathroom, the dreaded wet floor

Question 22

Antihypertensives and falls

Answer 22

• Antihypertensive medication use was not associated with an increased risk of falls
• Use of ACE-inhibitors reduced risk of injurious fall by 38%
• Use of Ca-channel blocker decreased all falls by 38%, indoor falls by 43%
• Larger doses of ACE-I and CaCBs were associated with a lower fall risk.

Question 23

examples of Benzodiazepines

Answer 23

• alprazolam (Xanax, Xanax XR)
• clobazam (Onfi)
• clonazepam (Klonopin)
• clorazepate (Tranxene)
• chlordiazepoxide (Librium)
• diazepam (Valium, Diastat Acudial, Diastat)
• lorazepam (Ativan)
• temazepam (Restoril)
• triazolam (Halcion)

Question 24

examples of Psychotropics

Answer 24

• Antipsychotics
• Antidepressants
• Antianxiety / Antipanic
• Stimulants
• Mood stabilizers