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Geriatrics > Geriatric Syndromes > Flashcards

Geriatric Syndromes Flashcards

1
Q

Define geriatric syndromes

A

Common health conditions in older adults that have multifactorial causes and do not fit into discrete disease categories

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2
Q

What are the implications of geriatric syndromes?

A

Predispose older adults to poor health outcomes, ↓ function and quality of life

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3
Q

What are some examples of geriatric syndromes?

A

Falls
Frailty
Cognitive impairment
Delirium
Urinary Incontinence
Iatrogenesis (including polypharmacy)

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4
Q

WHO Definition of Falls

A

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

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5
Q

Best preictor of falls in geriatrics. Risk of falls?

A

Best predictor of future falls = having a previous fall

Risk of falls ↑ with age

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6
Q

What is the best predictor of future falls?

A

Best predictor of future falls = having a previous fall

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7
Q

Is there a difference in risk of falls between the sexes in geriatrics?

A

Females are at an increased risk compared to males

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8
Q

What are the implications of falls regarding geriatric patients health and quality of life?

A

Most common mechanism of injury causing death in older adults
#1 cause of traumatic hospitalizations/non-fatal injuries in older adults

5-10% of falls result in serious injury:
Bone fractures
Head injury
Laceration

Account for 95% of hip fractures in older adults
20% of those who suffer a hip fracture die within a year
Another 20% will never live independently again

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9
Q

What is a syndrome that may develop from increased fall risk in geriatric patients? Consequences?

A

Fear of falling syndrome

When individuals restrict their activities due to the fear of falling

Activity avoidance –> deconditioning –> ↑ fall risk

Also leads to social isolation, low mood, decreased quality of life (QoL)

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10
Q

What are some risk factors for falls?

A

Medical/Biological

Pharmacological

Environmental

Social/Economic

Behavioural

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11
Q

What are some medical and biological risk factors for falls?

A

Deconditioning
–> ↓ muscle strength, ↓ balance, poor gait pattern

Vision impairment

Hearing Impairment

Orthostatic hypotension

Heart rate or rhythm abnormalities

Dizziness/syncope

Pain

Neuropathy

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12
Q

What are some medical conditions that may contribute to falls?

A

Medical conditions
–> Dementia, Parkinson’s disease, previous strokes, depression, diabetes

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13
Q

Risk of Falls and Medical Conditions RAte

A

–> Risk of falling is at least 2x higher in older adults with ≥ 4 chronic conditions1

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14
Q

What are some environmental risk factors for falls?

A

Home hazards
Clutter, pets, throw rugs, lighting, lack of handrails or other supports

Community hazards
Snow/ice, uneven pavement, curbs, potholes, slippery floors, obstacles or tripping hazards

Lack of familiarity with surroundings

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15
Q

What are some social/economic risk factors for falls?

A

Social isolation
Living alone
Lack of community or family supports
Lack of transportation
Low income

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16
Q

What is the risk of social isolation?

A

Social isolation has the same mortality and risk factors as smoking a pack of cigarettes a day.

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17
Q

What are some behavioural risk factors for falls?

A

Improper footwear choices
Rushing
Impulsivity/risk-taking
Fear of falling/activity restriction
(Lack of) use of assistive devices
Alcohol use

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18
Q

What are some of the ways that drugs may contribute to falls?

A

Drugs can contribute to falls in many ways:

1) Cognitive changes (anticholinergic drugs, Z drugs)

2) Movement disorders (secondary Parkinsonism) –> Anti-psychotics (FGA higher risk), metoclopramide (DA blocking effect)

3) Gait and balance changes –> BZD’s, Anti-convulsants

4) Muscles weakness

5) Dizziness, drowsiness

6) Vision changes –> Eye ointments, anticholinergics

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19
Q

Are drugs contribution to falls a direct consequence? WHy or Why not? Examples?

A

May also contribute indirectly:

Example: diuretic –> urinary urgency/frequency –> fall rushing to the bathroom

Polypharmacy (4+ concurrent medications) = ↑ fall risk

Absence of appropriate drug therapy may also ↑ fall risk indirectly
Example: lack of appropriate treatment for pain or COPD –> ↓ activity tolerance –> ↑ fall risk

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20
Q

Why should medications be evaluated in the context of falls?

A

Medication are an important, potentially modifiable risk factor for falls

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%1

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21
Q

What are some drug classes that increase one’s fall risk?

A

BZD
Anti-psychotics
Antidepresants
Anticholinergic Medications
CV Medications
Hypoglycemics
Anti-convulsants
Opiods

22
Q

BZD Reasons for Increasing Fall Risk

A

Muscle weakness, ↓ balance and coordination
Drowsiness, dizziness
Cognitive changes/confusion

23
Q

Anti-psychotic Examples and Reason for Increasing Fall Risk

A

Typical (e.g., haloperidol, chlorpromazine)
Atypical (e.g., risperidone, quetiapine, olanzapine)

Atypicals –> orthostatic hypotension

24
Q

Anti-depressants and fall risk examples

A

SSRIs
SNRIs
TCAs
Trazodone
Others (“any antidepressant”)

SSRI’s cause the same risk of falls as TCA”s

25
Q

What is a major consideration for BZD’s, AP’s and AD’s fall risk increase?

A

Require a slow, gradual taper!

26
Q

Anticholinergic Medication Risk of Falls

A

Effects of anticholinergic medications are cumulative

27
Q

How can a pharmacist analyze fall-risk increasing medications?

A

Anticholinergic Burden Scale

Reducing anticholinergic burden

28
Q

CV Medications and Fall Risk Example and Reason

A

Digoxin, Type I antiarrhythmic medication (e.g., procainamide, disopyramide) associated with ↑ risk

Data for antihypertensive medications is mixed
–> Monitoring BP, including postural vitals is important
–> Must weigh benefits of BP treatment with potential risks and adjust accordingly

29
Q

Hypoglycemics and Fall Risk Example and Reason

A

Hypoglycemia ↑↑ fall risk in older adults

Insulin has also been associated with ↑ fall risk
–> Hypoglycemia
–> Insulin is usually used in individuals with more advanced diabetes – may also have neuropathy, retinopathy which further compound fall risk

Other diabetes medications that cause hypoglycemia also have the potential to ↑ fall risk

Sulfonureas –> Do not sulfonureas as cause hypoglycemia

Repaglinide –> Insulin secretion effect; contributes to hypoglycemia and falls

30
Q

Anticonvulsants and fall risk examples and reason

A

Most data on ↑ fall risk with phenytoin, carbamazepine, and barbiturates

No comparative studies with newer anticonvulsants (e.g., lamotrigine, levetiracetam, pregabalin)

Meta-analyses analyzing anticonvulsants – any exposure ↑ risk

31
Q

Opiods and Fall Risks Evidence

A

Studies show mixed results

Data is conflicting so it’s important to weigh the risk vs benefit of opioid use for each patient (e.g., pain control vs fall risk)

32
Q

What is a way to assess fall risk? What is a major consideration in this assesment?

A

Multifactorial falls risk assessment recommended for:

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

Falls generally have multifactorial causes – interventions should be multifactorial as well

33
Q

What are some examples of multifactorial interventions for fall prevention ?

A

Vitamin D
Evidence is mixed; some studies and meta-analyses have shown ↓ fall risk with vitamin D supplementation (particularly in those with vitamin D levels)
Low-risk, low-cost

Fracture Prevention
Will not help prevent falls, but assessment and treatment for osteoporosis may help decrease fractures from falls
Particularly hip fractures

34
Q

Define frailty

A

Medical syndrome that increases an individual’s vulnerability to loss of independence and/or death

35
Q

How can frailty be characterized? Who is it more likely in?

A

Characterized by decreased strength, endurance and functional reserves –>
↑ vulnerability to stressors

Associated with ↑ age, ↑ number of medical comorbidities, women > men,
↓ socioeconomic status

36
Q

Is there a specific tool to identify frailty?

A

No universally-agreed-upon tool to identify who is “frail”

37
Q

What is the best predictor of frailty?

A

Best single-item predictor for frailty = gait speed

Predicts functional decline and mortality

Gait speed < 0.8 m/s (usually measured over 20m) correlates with frailty

38
Q

Describe the relationship between frailty and medications

A

Medication adverse effects may contribute to frailty

Medication –> nausea/GI upset –> ↓ appetite and weight loss –> Compounding muscle loss

Frailty also associated with ↑ risk of adverse drug reactions
–> Particularly for those on 5+ medications!

39
Q

How can fralty be managed?

A

Multifactorial causes –> multifactorial approaches

Comprehensive geriatric assessment

Exercise programs
Aerobic, balance, and strength training

Optimize health status
Treat underlying conditions as per goals of care

Streamline medications as much as possible

40
Q

Describe number of medications and some specific implications in:

1) falls
2) cognitive imapirment
3) functional status
4). nutrition

A
41
Q

Anti[psychotic Syndromes

A

Cogntive imapirment
Falls
UI
Depression

42
Q

Antidepressnat Syndromes

A

Delirium
Coigntive IMpairment
Falls
Unintentional weight Loss/Appetite Loss
UI

43
Q

Anti-epileptics Syndromes

A

Delirium
Coigntive IMpairment
Falls
Unintentional weight Loss/Appetite Loss
UI
Depression

44
Q

BZD Syndro,mes

A

Delirium
Cognitiove IMpairment
Falls

45
Q

Hypnotic Syndromes

A

Delirium
Cognitiove IMpairment
Falls

46
Q

Opiod Syndropmes

A

Delirium
Cognitivbe iMpairment
Falls
UI
Depressionm

47
Q

Anti-HTN Syndromes

A

Falls
UI
Depression

48
Q

Anti-arrthymic Sybndromes

A

Delirium
Cognitiove IMpairment
Falls

49
Q

Antidiabetes Syndromes

A

Falls
Unintentional Weight Loss/Appetite Loss

50
Q

Anticholinergic Syndromes

A

Delirium
Cogntive IMopairment
Falls
UI

Geriatrics (6 decks)

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