Lecture 7 Falls and safety, rest and sleep

Question 1

Age-related changes that affect sleep and rest

Answer 1

1. Decreased time in deep sleep (stages III and IV), resulting in sleep that is more fragmented.
2. Decreased amount of sleep.
3. Decreased restorative non-REM and REM sleep.
4. More daytime sleep.

Question 2

Sleep cycles/stages

Answer 2

1. One sleep cycle lasts 70-120 minutes and is a combination of sleep stages.
2. One sleep cycle includes 4 non-rapid eye movement (NREM) stages and 1 rapid eye movement (REM) stage.
3. Stage I is lightest sleep and stage IV is deepest sleep.

Question 3

REM cycles in the older adult

Answer 3

1. The number of REM cycles does not change with age, but the time spent in each REM cycle is shorter.
2. REM cycles occur predominately during the second half of the night (rather than throughout the night as in younger adults).

Question 4

_ sleep is often absent in older adults.

Answer 4

Stage IV.

Question 5

While sleeping, older adults spend approximately _ of the night in Stage I sleep, compared with _ for younger adults.

Answer 5

20%; 5%.

Question 6

Melatonin

Answer 6

The hormone that promotes sleep; production declines with age.

Question 7

Sleep latency

Answer 7

1. The time required to fall asleep.

2. Decreased sleep efficiency is attributed to prolonged sleep latency.

Question 8

Medications that can suppress REM include _

Answer 8

1. Alcohol.
2. Barbiturates.
3. Antidepressants.

Question 9

Effects of anticholinergics that are detrimental to sleep include _

Answer 9

1. Hyperreflexia.
2. Overactivity.
3. Muscle twitching.

Question 10

Beta blockers can interfere with sleep by causing _

Answer 10

Nightmares.

Question 11

Insomnia

Answer 11

Repeated difficulty with sleep initiation, duration, consolidation, or sleep quality despite adequate time and opportunity for sleep; associated with daytime impairment.

Question 12

The first-line treatment for insomnia is _

Answer 12

Cognitive behavioral therapy (CBT) - this is tried before medications.

Question 13

Using _ to treat insomnia is usually a last resort, and therapy is limited to 10-14 days.

Answer 13

Benzodiazepines (e.g., temazepam (Restoril)).

Question 14

Obstructive sleep apnea (OSA)

Answer 14

1. Chronic sleep disorder involving the involuntary cessation of airflow for 10 seconds or longer, occurring more than 5-8 times per hour.
2. OSA is most common in men; prevalence increases with age.
3. Associated with hypertension, obesity, and daytime sleepiness.
4. Treatment: Surgery or continuous positive airway pressure (CPAP) devices.

Question 15

Pittsburgh Sleep Quality Index (PSQI)

Answer 15

An evidence-based assessment tool that assesses sleep quality and patterns over the past month.

Question 16

Epworth Sleepiness Scale (ESS)

Answer 16

An evidence-based assessment tool that focuses on daytime sleepiness over the preceding week.

Question 17

60% of falls among people age 65 and older occur in _

Answer 17

The home.

Question 18

_ after a fall can reduce medical costs and severity of complications by up to 70%.

Answer 18

Early intervention.

Question 19

Almost 50% of older adults who fall cannot get back up without assistance, and physiological changes occur within _ of not receiving immediate assistance.

Answer 19

2 hours.

Question 20

About _ people age 65 and older are treated in emergency rooms for injuries from falls every year.

Answer 20

2.4 million.

Question 21

Mortality rates and lie times after falling

Answer 21

1. 12% when a lie time is less than 1 hour.

2. 67% when a lie time is 72 hours or longer.

Question 22

Rhabdomyolysis

Answer 22

1. Muscle breakdown due to trauma or muscle compression; results from immobility in conscious individuals forced to lie in one position for hours.
2. Triggers a sequence of events: Protein is released into the blood, kidneys become clogged, and acute renal failure can result.

Question 23

Dehydration risks are increased in the elderly due to _

Answer 23

1. Altered body water composition.

2. Reduced thirst perception.

Question 24

_ is one of the best indicators that dehydration has become severe.

Answer 24

Confusion.

Question 25

Age-related changes impacting bone health

Answer 25

1. ↑ bone reabsorption.
2. ↓ calcium absorption.
3. ↑ serum parathyroid hormone.
4. Impaired regulation of osteoblast activity.
5. ↓ estrogen.
6. Impaired bone formation.
7. Loss of bone mass.

Question 26

Sarcopenia

Answer 26

Loss of muscle mass, strength, and endurance.

Question 27

Non-modifiable risk factors for osteoporosis

Answer 27

1. Female gender over age 50.
2. Caucasian or Asian individuals.
3. People with a family history of osteoporosis.
4. People with altered bone structure.

Question 28

Modifiable risk factors for osteoporosis

Answer 28

1. Inactivity, especially lack of weight-bearing exercises.
2. Nutritional deficits (calcium, vitamin D, vitamin B12, folic acid, protein).
3. Cigarette smoking.
4. Excessive alcohol consumption.

Question 29

Although osteoporosis occurs in both men and women, the onset is _ in women.

Answer 29

A decade earlier.

Question 30

Falling

Answer 30

1. A sudden unintentional change in position causing one to land on a lower level.
2. Does not include “near falls”, incidents due to an overwhelming external force, or loss of consciousness.
3. Falls are the leading cause of fatal and nonfatal injuries in the United States, and the leading cause of traumatic brain injury (TBI).
4. 1 out of 3 older adults fall each year, but less than half report this to their health care provider.

Question 31

“Fear of Falling” video (1 of 2)

Answer 31

1. Fear of falling is increased by an older adult’s awareness that their sense of balance is not what it used to be.
2. The fear of falling leads to a decrease in mobility (a physical cost); the older adult may avoid leaving the home (a social cost).
3. Concern about the loss of independence after a fall is the leading contributor to the fear of falling.

Question 32

“Fear of Falling” video (2 of 2)

Answer 32

1. Inactivity is a risk factor for falls although many older adults think that they are being cautious by limiting their activity.
2. 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.
3. Staying active is the best thing that older adults can do to prevent falls.

Question 33

Hendrich II Model

Answer 33

1. An evidence-based tool for assessing fall risk in older adults.
2. Risk factors: Confusion/disorientation; symptomatic depression; altered elimination; dizziness/vertigo; male gender; anticonvulsant medications; benzodiazepines.
3. Also tests a person’s ability to rise from a chair - number of attempts, etc.

Question 34

The two classes of medications most frequently associated with secondary osteoporosis are _

Answer 34

1. Corticosteroids.

2. Anti-seizure medications.

Question 35

A non-pharmacologic intervention for osteoarthritis-related pain is the application of _

Answer 35

Moist heat.

Question 36

The symptoms of individuals with COPD are often exacerbated during sleep, because of _

Answer 36

1. Positioning.

2. Decreased oxygen saturation that occurs during sleep.

Question 37

Restless legs syndrome (RLS)

Answer 37

1. A neuromuscular disorder in which a person feels a strong urge to move their legs while at rest, interfering with sleep.
2. Risk factors: Iron deficiency, chronic renal failure, peripheral neuropathy, adverse effects of certain medications.

Question 38

A score of 5 or greater on the Hendrich II Fall Risk Model indicates _

Answer 38

High risk.

Question 39

Using the Timed Up and Go (TUG) Test, normal mobility is indicated by a time of _

Answer 39

10 seconds or less.