Geriatric Syndromes Flashcards
What is a geriatric syndrome?
common health conditions in older adults that have multifactorial causes and do not fit into discrete disease categories
-predispose older adults to poor health outcomes, decreased function, and quality of life
What are examples of geriatric syndromes?
falls
frailty
cognitive impairment
delirium
urinary incontinence
iatrogenesis
What is the WHO definition of a fall?
an event which results in a person coming to rest inadvertently on the ground or other lower level
What is the best predictor of future falls?
having a previous fall
-risk of falls increases with age
How frequently is an older Canadian hospitalized for a fall?
every 10 minutes
What is the #1 mechanism of injury causing death in older adults?
falls
What is the #1 cause of traumatic hospitalizations/non-fatal injuries in older adults?
falls
What percentage of falls result in serious injury?
5-10%
What percentage of hip fractures are due to falls in older adults?
95%
-20% of those who suffer a hip fracture die within a year
-20% will never live independently again
Describe fear of falling syndrome.
when individuals restrict their activities due to the fear of falling
-activity avoidance –> deconditioning –> increased fall risk
-also leads to social isolation, low mood, decreased QoL
What are the complications of falls?
injuries
-painful soft tissue injuries
-fractures
subdural hematoma
hospitalization
disability
increased risk of institutionalization
increased risk of death
Where do the majority of falls occur?
at home
-chance to get OT involved to assess risks
What are the risk factors for falls?
medical/biological
pharmacological
environmental
social/economic
behavioral
What are some medical/biological risk factors for falls?
deconditioning
vision impairment
hearing impairment
orthostatic hypotension
heart rate or rhythm abnormalities
dizziness/syncope
pain
neuropathy
medical conditions
-prev stroke, dementia, Parkinsons, depression diabetes
What are some environmental risk factors for falls?
home hazards
community hazards
lack of familiarity with surroundings
What are some social/economic risk factors for falls?
social isolation
living alone
lack of community or family supports
lack of transportation
low income
What are some behavioral risk factors for falls?
improper footwear choices
rushing
impulsivity/risk-taking
fear of falling/activity restriction
(lack of) assistive device use
alcohol use
What are the many ways that drugs can contribute to falls?
cognitive changes
movement disorders
gait and balance changes
muscle weakness
dizziness, drowsiness
vision changes
How can medications indirectly contribute to fall risk?
ex: diuretic –> urge –> fall rushing to bathroom
-polypharmacy = increased fall risk
absence of appropriate therapy may increase fall risk indirectly
-ex: lack of appropriate tx for pain or COPD –> decreased activity tolerance –> increased fall risk
What is an important potentially modifiable risk factor for falls?
medications
-numerous fall-risk increasing drugs (FRIDs) = try to minimize exposure as much as possible
studies have shown withdrawal of FRIDs reduces fall risk by 50-60%
What are examples of drug classes that increase fall risk?
benzodiazepines
antipsychotics
antidepressants
anticholinergics
CV medications
hypoglycemics
anticonvulsants
opioids?
How do benzos increase fall risk?
muscle weakness, decreased balance and coordination
drowsiness, dizziness
cognitive changes/confusion
Which antihistamines have minimal anticholinergic burden? Which have severe anticholinergic burden?
minimal: desloratidine, fexofenadine
severe: chlorpheniramine, clemastine
Which antidepressants have minimal anticholinergic burden? Which have severe anticholinergic burden?
minimal: venlafaxine, duloxetine, bupropion, trazodone
severe: TCAs
Which CV medications are associated with increased fall risk?
digoxin and type I antiarrhythmics (procainamide, disopyramide)
data for antihypertensives is mixed
-monitoring BP, including postural vitals is important
-must weigh benefits of BP treatment vs risks
Which hypoglycemics are associated with increased fall risk?
insulin
-hypoglycemia
other diabetes meds that cause hypoglycemia (SU, repaglinide)
Which anticonvulsants increase fall risk?
most data on phenytoin, CBZ, barbiturates
no comparative studies with newer anticonvulsants (lamotrigine, levetiracetam, pregabalin)
meta-analyses analyzing anticonvulsants say any exposure increases risk
What is the risk of falls with opioids?
studies show mixed results
Who is it recommended to do a multifactorial falls risk assessment for?
individuals that have fallen 2+ times in the past 12 months
after an acute fall
gait or balance difficulties
What are some multifactorial interventions for fall prevention?
ambulatory assistive devices and protective equipment
clinical disease management
education
environmental modification
exercise programs
medications reviews and modification
nutrition and supplements
vision referrals and correction
What is the evidence for vitamin D in fall prevention?
evidence is mixed
-some studies and meta-analyses have shown decreased fall risk with vitamin D supplementation
-low risk, low cost
What is frailty?
medical syndrome that increases an individuals vulnerability to loss of independence and/or death
-characterized by decreased strength, endurance and functional reserves –> increased vulnerability to stressors
associated with aging, number of medical conditions, women > men, decreases SES
What is the best single-item predictor for frailty?
gait speed
-predicts functional decline and mortality
-gait speed < 0.8 m/s correlates with frailty
How can medications contribute to frailty?
medication –> nausea/GI upset –> decreased appetite and weight loss
medication –> fatigue –> decreased activity –> deconditioning
frailty also associated with increased risk of ADRs
-particularly if on 5+ drugs
What is the importance of considering frailty and interventions?
frailty has emerged as an important consideration when evaluating the appropriateness of certain interventions
-e.g. glycemic targets
need to consider the impact of medications on the individuals ability to function
