Preventative Activities in Older Age

Question 1

Vulnerability factors

Answer 1

• recent discharge from hospital or other facility
• significant changes made to medication treatment regimen in the past three months
• high-risk drug groups (eg those with a narrow therapeutic index and those that cause xerostomia)
• confusion/cognitive impairment or dementia
• other causes of difficulty managing medications including literacy, language issues, dexterity problems, sight impairment
• inability to manage therapeutic devices
• history of falls
• currently taking five or more regular medications
• taking >12 doses of medication per day
• patients attending multiple doctors including GPs and specialists
• disease states where medication management is an important process of care (chronic kidney disease, congestive cardiac failure)18
• multiple chronic medical problems
• regular use of alcohol
• previous adverse drug reaction
• anticholinergic load.

Question 2

Immunisation: Preventive interventions in older age

Answer 2

Flu
Pneumococcal
Herpes

Question 3

Physical activity

Answer 3

Older people:
• should do some form of physical activity, no matter what their age, weight, health problems or abilities
• should be active every day in as many ways as possible, doing a range of physical activities that incorporate fitness, strength, balance and flexibility
• should accumulate at least 30 minutes of moderate intensity physical activity on most, preferably all, days
• who have stopped physical activity, or who are starting a new physical activity, should start at a level that is easily manageable and gradually build up to the recommended amount, type and frequency of activity
• who continue to enjoy a lifetime of vigorous physical activity should carry on doing so in a manner suited to their capability into later life, provided recommended safety procedures and guidelines are adhered to.

Question 4

Falls

Answer 4

Average risk:
• All people aged ≥65 years
- Screen Every 12 months

Moderately high risk:
• Older people presenting with one or more falls, who report recurrent falls or with multiple risk factors
- Monitor Every six months

Question 5

Components for falls prevention

Answer 5

Screening for falls risk

• Hx
• PE
• Cognitive and functional impairment

Falls risk reduction

• Exercise program
• Regular med review
• Osteoporesis risk
• Home assessment
• MDT

Question 6

Screening for falls risk

Answer 6

Ask the following three screening questions:

1. Have you had two or more falls in the past 12 months?
2. Are you presenting following a fall?
3. Are you having difficulty with walking or balance?

If the answers to any of these are positive, complete a multifactorial risk assessment including obtaining relevant medical history, completing a physical examination, and performing cognitive and functional assessments

• History should include:
– detailed history of falls (eg how many falls?, at home or outdoors?,
patient perception of causes, any fear of falling)
– multiple medications, and specific medications (eg psychotropic
medications)
– impaired gait, balance and mobility
– foot pain and deformities, and unsafe footwear
– home hazards
– bifocal or multifocal spectacle use
– incontinence
– recent discharge from hospital
– chronic illness such as stroke, multiple sclerosis (MS), Parkinson’s
disease, cognitive impairment/dementia
– vitamin D deficiency/poor sun exposure if housebound or in a care
facility

• Physical examination should include:
– impaired visual acuity, including cataracts
– reduced visual fields
– muscle weakness
– neurological impairment
– cardiac dysrhythmias
– postural hypotension
– six-metre walk, balance, sit-to-stand*

• Cognitive and functional impairments should include:
– dementia/cognitive impairment assessment (eg General Practitioner
Assessment of Cognition [GPCOG])
– activities of daily living and home assessment as appropriate (eg by
occupational therapist)
– falls risk–assessment tools
– if unsteady, gait and mobility assessment by physiotherapist

There are many fall risk–assessment tools. However, reports from researchers are variable, so no single tool can be recommended for implementation in all settings or for all subpopulations within each setting

Question 7

Falls risk reduction

Answer 7

Exercise guidelines for fall prevention recommend the following:
• Exercise that specifically challenges balance is the most effective physical activity intervention to prevent falls
• Exercise needs to be done for at least two hours per week and continue as a lifetime activity
• Fall prevention exercises can be home-based or a group program.
• Walking or strength training as a single intervention does not appear to
prevent falls

Regularly review medication. Encourage patients to keep a medication review card. Reduce dose to address side effects and dose sensitivity, and stop medications that are no longer needed
Medications that can promote falls include psychotropic medications, and medications with anticholinergic activity, sedation effects and hypotensive effects or orthostatic hypotensive side effects
Also refer to Chapter 14. Osteoporosis
A home assessment should be considered for those at moderately high to high risk of falls. Occupational therapy interventions can reduce fall hazards, raise awareness of fall risk and implement safety strategies. Referral should specify fall prevention
Other risk factors should be managed actively including:
• using a multidisciplinary team (eg podiatrist regarding foot problems, optometrist regarding avoidance of multifocal lenses, physiotherapist or nurse regarding urge incontinence)
• referring to relevant medical specialists (eg ophthalmologist for cataract surgery, cardiologist for consideration of pacemaker)
• investigating the causes of dizziness

Question 8

Prevention in older age - components

Answer 8

1. Falls
2. Cognitive decline
3. Visual Impairment
4. Vaccines