Lecture 7 Falls and safety, rest and sleep Flashcards
Age-related changes that affect sleep and rest
- Decreased time in deep sleep (stages III and IV), resulting in sleep that is more fragmented.
- Decreased amount of sleep.
- Decreased restorative non-REM and REM sleep.
- More daytime sleep.
Sleep cycles/stages
- One sleep cycle lasts 70-120 minutes and is a combination of sleep stages.
- One sleep cycle includes 4 non-rapid eye movement (NREM) stages and 1 rapid eye movement (REM) stage.
- Stage I is lightest sleep and stage IV is deepest sleep.
REM cycles in the older adult
- The number of REM cycles does not change with age, but the time spent in each REM cycle is shorter.
- REM cycles occur predominately during the second half of the night (rather than throughout the night as in younger adults).
_ sleep is often absent in older adults.
Stage IV.
While sleeping, older adults spend approximately _ of the night in Stage I sleep, compared with _ for younger adults.
20%; 5%.
Melatonin
The hormone that promotes sleep; production declines with age.
Sleep latency
- The time required to fall asleep.
2. Decreased sleep efficiency is attributed to prolonged sleep latency.
Medications that can suppress REM include _
- Alcohol.
- Barbiturates.
- Antidepressants.
Effects of anticholinergics that are detrimental to sleep include _
- Hyperreflexia.
- Overactivity.
- Muscle twitching.
Beta blockers can interfere with sleep by causing _
Nightmares.
Insomnia
Repeated difficulty with sleep initiation, duration, consolidation, or sleep quality despite adequate time and opportunity for sleep; associated with daytime impairment.
The first-line treatment for insomnia is _
Cognitive behavioral therapy (CBT) - this is tried before medications.
Using _ to treat insomnia is usually a last resort, and therapy is limited to 10-14 days.
Benzodiazepines (e.g., temazepam (Restoril)).
Obstructive sleep apnea (OSA)
- Chronic sleep disorder involving the involuntary cessation of airflow for 10 seconds or longer, occurring more than 5-8 times per hour.
- OSA is most common in men; prevalence increases with age.
- Associated with hypertension, obesity, and daytime sleepiness.
- Treatment: Surgery or continuous positive airway pressure (CPAP) devices.
Pittsburgh Sleep Quality Index (PSQI)
An evidence-based assessment tool that assesses sleep quality and patterns over the past month.
Epworth Sleepiness Scale (ESS)
An evidence-based assessment tool that focuses on daytime sleepiness over the preceding week.
60% of falls among people age 65 and older occur in _
The home.
_ after a fall can reduce medical costs and severity of complications by up to 70%.
Early intervention.
Almost 50% of older adults who fall cannot get back up without assistance, and physiological changes occur within _ of not receiving immediate assistance.
2 hours.
About _ people age 65 and older are treated in emergency rooms for injuries from falls every year.
2.4 million.
Mortality rates and lie times after falling
- 12% when a lie time is less than 1 hour.
2. 67% when a lie time is 72 hours or longer.
Rhabdomyolysis
- Muscle breakdown due to trauma or muscle compression; results from immobility in conscious individuals forced to lie in one position for hours.
- Triggers a sequence of events: Protein is released into the blood, kidneys become clogged, and acute renal failure can result.
Dehydration risks are increased in the elderly due to _
- Altered body water composition.
2. Reduced thirst perception.
_ is one of the best indicators that dehydration has become severe.
Confusion.
Age-related changes impacting bone health
- ↑ bone reabsorption.
- ↓ calcium absorption.
- ↑ serum parathyroid hormone.
- Impaired regulation of osteoblast activity.
- ↓ estrogen.
- Impaired bone formation.
- Loss of bone mass.
Sarcopenia
Loss of muscle mass, strength, and endurance.
Non-modifiable risk factors for osteoporosis
- Female gender over age 50.
- Caucasian or Asian individuals.
- People with a family history of osteoporosis.
- People with altered bone structure.
Modifiable risk factors for osteoporosis
- Inactivity, especially lack of weight-bearing exercises.
- Nutritional deficits (calcium, vitamin D, vitamin B12, folic acid, protein).
- Cigarette smoking.
- Excessive alcohol consumption.
Although osteoporosis occurs in both men and women, the onset is _ in women.
A decade earlier.
Falling
- A sudden unintentional change in position causing one to land on a lower level.
- Does not include “near falls”, incidents due to an overwhelming external force, or loss of consciousness.
- Falls are the leading cause of fatal and nonfatal injuries in the United States, and the leading cause of traumatic brain injury (TBI).
- 1 out of 3 older adults fall each year, but less than half report this to their health care provider.
“Fear of Falling” video (1 of 2)
- Fear of falling is increased by an older adult’s awareness that their sense of balance is not what it used to be.
- The fear of falling leads to a decrease in mobility (a physical cost); the older adult may avoid leaving the home (a social cost).
- Concern about the loss of independence after a fall is the leading contributor to the fear of falling.
“Fear of Falling” video (2 of 2)
- Inactivity is a risk factor for falls although many older adults think that they are being cautious by limiting their activity.
- Falls in the home can be prevented through the use of assistive devices, by rearranging items (cabinets, etc.) to make things easier to reach, more lighting, etc.
- Staying active is the best thing that older adults can do to prevent falls.
Hendrich II Model
- An evidence-based tool for assessing fall risk in older adults.
- Risk factors: Confusion/disorientation; symptomatic depression; altered elimination; dizziness/vertigo; male gender; anticonvulsant medications; benzodiazepines.
- Also tests a person’s ability to rise from a chair - number of attempts, etc.
The two classes of medications most frequently associated with secondary osteoporosis are _
- Corticosteroids.
2. Anti-seizure medications.
A non-pharmacologic intervention for osteoarthritis-related pain is the application of _
Moist heat.
The symptoms of individuals with COPD are often exacerbated during sleep, because of _
- Positioning.
2. Decreased oxygen saturation that occurs during sleep.
Restless legs syndrome (RLS)
- A neuromuscular disorder in which a person feels a strong urge to move their legs while at rest, interfering with sleep.
- Risk factors: Iron deficiency, chronic renal failure, peripheral neuropathy, adverse effects of certain medications.
A score of 5 or greater on the Hendrich II Fall Risk Model indicates _
High risk.
Using the Timed Up and Go (TUG) Test, normal mobility is indicated by a time of _
10 seconds or less.
