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PHAR 350 > Geriatric Syndromes > Flashcards

Geriatric Syndromes Flashcards

1
Q

What are geriatric syndromes? (2)

A
  1. Common health conditions in older adults that have multifactorial causes and do not fit into discrete disease categories
  2. Predispose older adults to poor health outcomes, decrease function and QoL
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2
Q

What are 6 examples of geriatric syndromes?

A
  1. Falls
  2. Frailty
  3. Cognitive impairment
  4. Delirium
  5. Urinary Incontinence
  6. Iatrogenesis (including polypharmacy)
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3
Q

Define a fall

A

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

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4
Q

Why do we care about falls? (4)

A

Common in older adults
1. 20-30% fall each year
2. Best predictor of future falls = having a previous fall
3. Risk of falls increases with age
4. On average, every 10 minutes an older Canadian is hospitalized due to a fall

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5
Q

Falls are number 1 in what 2 things in older adults?

A
  1. # 1 mechanism of injury causing death in older adults
  2. # 1 cause of traumatic hospitalizations/non-fatal injuries in older adults
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6
Q

Falls account for 95% of hip fractures in older adults. What can that lead to? (2)

A
  1. 20% of those who suffer a hip fracture die within a year
  2. Another 20% will never live independently again
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7
Q

What is fear of falling syndrome?
What does that lead to? (3 total)

A
  1. When individuals restrict their activities due to the fear of falling
  2. Activity avoidance –> deconditioning –> increased fall risk
  3. Also leads to social isolation, low mood, decreased QoL
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8
Q

What are the complications of falls in older adults? (6)

A
  1. Injuries
    - Painful soft tissue
    - Fractures
  2. Subdural hematoma
  3. Hospitalization
    - Complications of immobilization
    - Risk of iatrogenic illness
  4. Disability
  5. Increased risk of institutionalization
  6. Increased risk of death
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9
Q

What are the 5 classes of risk factors for falls?

A
  1. Medical/biological
  2. Pharmacological
  3. Environmental
  4. Social/economic
  5. Behavioural
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10
Q

What are the medical/biological risk factors for falls? (9)

A
  1. Deconditioning
    - Decreased muscle strength, decreased balance, poor gait pattern
  2. Vision impairment
  3. Hearing Impairment
  4. Orthostatic hypotension
  5. Heart rate or rhythm abnormalities
  6. Dizziness/syncope
  7. Pain
  8. Neuropathy
  9. Medical conditions
    - Dementia, Parkinson’s disease, previous strokes, depression, diabetes
    - Risk of falling is at least 2x higher in older adults with ≥ 4 chronic conditions
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11
Q

What are the environmental risk factors for falls? (3)

A
  1. Home hazards
    - Clutter, pets, throw rugs, lighting, lack of handrails or other supports
  2. Community hazards
    - Snow/ice, uneven pavement, curbs, potholes, slippery floors, obstacles or tripping hazards
  3. Lack of familiarity with surroundings
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12
Q

What are some easy ways to avoid falls at home (that is, how can the environment in the home be optimized?) (6)

A
  1. Non-slip floors
  2. Grab bars
  3. Better lighting
  4. Remove clutter
  5. Repair flooring
  6. Hand rails
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13
Q

What are the social/economic risk factors for falls? (5)

A
  1. Social isolation
  2. Living alone
  3. Lack of community or family supports
  4. Lack of transportation
  5. Low income
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14
Q

______ _________ has the same mortality and risk factors as smoking a pack of cigarettes a day

A

Social isolation

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15
Q

What are the behavioural risk factors for falls? (6)

A
  1. Improper footwear choices
  2. Rushing
  3. Impulsivity/risk-taking
  4. Fear of falling/activity restriction
  5. (Lack of) use of assistive devices
  6. Alcohol use
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16
Q

Drugs may contribute to falls in various ways. Such as? (6)

A
  1. Cognitive changes
  2. Movement disorders (secondary Parkinsonism)
  3. Gait and balance changes
  4. Muscles weakness
  5. Dizziness, drowsiness
  6. Vision changes
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17
Q

Medications may contribute indirectly to falls. How so? (2)

A
  1. Example: diuretic –> urinary urgency/frequency –> fall rushing to the bathroom
  2. Polypharmacy (4+ concurrent meds) = increased fall risk
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18
Q

Absence of appropriate drug therapy may also increase fall risk indirectly. Give an example as to how

A

E.g., lack of appropriate treatment for pain or COPD –> decreases activity tolerance –> increased fall risk

19
Q

How do benzos contribute to falls? (3)

A
  1. Muscle weakness, ↓ balance and coordination
  2. Drowsiness, dizziness
  3. Cognitive changes/confusion
20
Q

What antipsychotics have increased fall risk? (2 groups, 2 and 3 examples)

A
  1. Typical
    - Haloperidol
    - Chlorpromazine
  2. Atypical
    - Risperidone
    - Quetiapine
    - Olanzapine
21
Q

Which of the antidepressants are more anticholinergic and contribute to fall risk in older adults? (2)

A
  1. TCAs
    - AmiTRIPtyline
  2. Paroxetine
22
Q

What antiemtic is more anticholinergic and contributes to fall risk in older adults?

A

Dimenhydrinate

23
Q

What antihistamines are more anticholinergic and contribute to fall risk in older adults? (3)

A
  1. Dimenhydrinate
  2. Diphenhydramine
  3. Hydroxyzine
24
Q

What is an antimuscarinic that contributes to fall risk?

A

Oxybutynin

25
Q

What is an antiparkinsonian drug that contributes to fall risk?

A

Amantadine

26
Q

What are 2 antiseizure drugs that are anticholinergic and contribute to fall risk?

A
  1. Carbamazepine
  2. Oxcarbazepine
27
Q

What are some GI agents that are more anticholinergic and contribute to fall risk? (2)

A
  1. Loperamide
  2. Ranitidine
28
Q

What are some muscle relaxants that are more anticholinergic and contribute to fall risk? (3)

A
  1. Baclofen
  2. Cyclobenzaprine
  3. Methocarbamol
29
Q

What are some CV meds that increase fall risk? (2)

A
  1. Digoxin
  2. Type I antiarrhythmic meds (e.g., procainamide, disopyramide)
30
Q

Insulin has been associated with increased fall risks why?

A

Because of potential hypoglycemia, duh

31
Q

Do opioids contribute to fall risk?

A

Mixed results from studies

32
Q

Multifactorial risk assessment is recommended for: (3)

A
  1. Individuals that have fallen 2+ times in the past 12 months
  2. After an acute fall
  3. Gait or balance difficulties
33
Q

What are some multifactorial interventions for fall prevention? (8)

A
  1. Ambulatory assistive devices and protective equipment
  2. Clinical disease management
  3. Education
  4. Environmental modification
  5. Exercise programs
  6. Medication review and modification
  7. Nutrition and supplements
  8. Vision referral and correction
34
Q

Vitamin D for fall prevention. Yay or nay?

A

Mixed results, but it’s low risk low cost so might as well

35
Q

Fracture prevention does not prevent falls, but what is it good for?

A

Assessment and treatment of osteoporosis may help decrease fractures from falls, especially hip fractures

36
Q

What is frailty?
What is it characterized by?

A
  1. Medical syndrome that increases an individual’s vulnerability to loss of independence and/or death
  2. Characterized by decreased strength, endurance and functional reserves –> ↑ vulnerability to stressors
37
Q

Frailty is associated with: (4)

A
  1. Increased age
  2. Increased number of medical comorbidities
  3. Women > men
  4. Lower SES
38
Q

The best single-item predictor for frailty is?

A

Gait speed
- Predicts functional decline and mortality
- Gait speed < 0.8 m/s (usually measured over 20m) correlates with frailty

39
Q

Medication adverse effects may contribute to frailty. How so? (2)

A
  1. Medication –> nausea/GI upset –> ↓ appetite and weight loss
  2. Medication –> fatigue –> ↓ activity –> deconditioning
40
Q

How might frailty be managed? (4)

A
  1. Multifactorial causes –> multifactorial approaches
    - Comprehensive geriatric assessment
  2. Exercise programs
    - Aerobics, balance, and strength training
  3. Optimize health status
    - Treat underlying conditions as per goals of care
  4. Streamline medications as much as possible
41
Q

Use of ≥_ medications is associated with increased fall risk

A

4

42
Q

How are number of meds associated with cognitive impairment?

A

Impaired cognition in 22% of older adults taking <5 meds vs. 54% of those taking ≥10 meds

43
Q

Half of patients taking ≥__ medications were found to be malnourished

A

10

PHAR 350 (6 decks)

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