Geriatric Syndromes

Question 1

What is a geriatric syndrome?

Answer 1

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

Question 2

What are examples of geriatric syndromes?

Answer 2

falls
frailty
cognitive impairment
delirium
urinary incontinence
iatrogenesis

Question 3

What is the WHO definition of a fall?

Answer 3

an event which results in a person coming to rest inadvertently on the ground or other lower level

Question 4

What is the best predictor of future falls?

Answer 4

having a previous fall
-risk of falls increases with age

Question 5

How frequently is an older Canadian hospitalized for a fall?

Answer 5

every 10 minutes

Question 6

What is the #1 mechanism of injury causing death in older adults?

Answer 6

falls

Question 7

What is the #1 cause of traumatic hospitalizations/non-fatal injuries in older adults?

Answer 7

falls

Question 8

What percentage of falls result in serious injury?

Answer 8

5-10%

Question 9

What percentage of hip fractures are due to falls in older adults?

Answer 9

95%
-20% of those who suffer a hip fracture die within a year
-20% will never live independently again

Question 10

Describe fear of falling syndrome.

Answer 10

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

Question 11

What are the complications of falls?

Answer 11

injuries
-painful soft tissue injuries
-fractures
subdural hematoma
hospitalization
disability
increased risk of institutionalization
increased risk of death

Question 12

Where do the majority of falls occur?

Answer 12

at home
-chance to get OT involved to assess risks

Question 13

What are the risk factors for falls?

Answer 13

medical/biological
pharmacological
environmental
social/economic
behavioral

Question 14

What are some medical/biological risk factors for falls?

Answer 14

deconditioning
vision impairment
hearing impairment
orthostatic hypotension
heart rate or rhythm abnormalities
dizziness/syncope
pain
neuropathy
medical conditions
-prev stroke, dementia, Parkinsons, depression diabetes

Question 15

What are some environmental risk factors for falls?

Answer 15

home hazards
community hazards
lack of familiarity with surroundings

Question 16

What are some social/economic risk factors for falls?

Answer 16

social isolation
living alone
lack of community or family supports
lack of transportation
low income

Question 17

What are some behavioral risk factors for falls?

Answer 17

improper footwear choices
rushing
impulsivity/risk-taking
fear of falling/activity restriction
(lack of) assistive device use
alcohol use

Question 18

What are the many ways that drugs can contribute to falls?

Answer 18

cognitive changes
movement disorders
gait and balance changes
muscle weakness
dizziness, drowsiness
vision changes

Question 19

How can medications indirectly contribute to fall risk?

Answer 19

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

Question 20

What is an important potentially modifiable risk factor for falls?

Answer 20

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%

Question 21

What are examples of drug classes that increase fall risk?

Answer 21

benzodiazepines
antipsychotics
antidepressants
anticholinergics
CV medications
hypoglycemics
anticonvulsants
opioids?

Question 22

How do benzos increase fall risk?

Answer 22

muscle weakness, decreased balance and coordination
drowsiness, dizziness
cognitive changes/confusion

Question 23

Which antihistamines have minimal anticholinergic burden? Which have severe anticholinergic burden?

Answer 23

minimal: desloratidine, fexofenadine
severe: chlorpheniramine, clemastine

Question 24

Which antidepressants have minimal anticholinergic burden? Which have severe anticholinergic burden?

Answer 24

minimal: venlafaxine, duloxetine, bupropion, trazodone
severe: TCAs

Question 25

Which CV medications are associated with increased fall risk?

Answer 25

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

Question 26

Which hypoglycemics are associated with increased fall risk?

Answer 26

insulin
-hypoglycemia
other diabetes meds that cause hypoglycemia (SU, repaglinide)

Question 27

Which anticonvulsants increase fall risk?

Answer 27

most data on phenytoin, CBZ, barbiturates
no comparative studies with newer anticonvulsants (lamotrigine, levetiracetam, pregabalin)
meta-analyses analyzing anticonvulsants say any exposure increases risk

Question 28

What is the risk of falls with opioids?

Answer 28

studies show mixed results

Question 29

Who is it recommended to do a multifactorial falls risk assessment for?

Answer 29

individuals that have fallen 2+ times in the past 12 months
after an acute fall
gait or balance difficulties

Question 30

What are some multifactorial interventions for fall prevention?

Answer 30

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

Question 31

What is the evidence for vitamin D in fall prevention?

Answer 31

evidence is mixed
-some studies and meta-analyses have shown decreased fall risk with vitamin D supplementation
-low risk, low cost

Question 32

What is frailty?

Answer 32

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

Question 33

What is the best single-item predictor for frailty?

Answer 33

gait speed
-predicts functional decline and mortality
-gait speed < 0.8 m/s correlates with frailty

Question 34

How can medications contribute to frailty?

Answer 34

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

Question 35

What is the importance of considering frailty and interventions?

Answer 35

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