WEEK 3: Falls, osteoporotic fractures, & care in elderly people Flashcards
Why are they low fractures in Africa compared to western countries?
Low old people population hence less osteoporotic fractures.
State 4 reasons why Hip fractures are of special interest.
*Greatly limit mobility and independence
*Require major surgery (hip replacement)
* Require rehabilitation
* Reduce one’s lifespan by an ~6-7 yrs. (estimated loss of remaining years greater in the elderly and even in young adults)
State the Impact of falls on society.
*Falling impacts quality of life, health and health care costs.
*Older adults have a higher risk of accidental injury that results in hospitalization or death than any other age group.
Name the drug that a research was done on and associated with bone mineral loss in people living with HIV.
During a trial of tenofovir and FTC (emtricitabine) as pre-exposure prophylaxis (PrEP) in Botswana researchers found low bone mineral density (BMD) levels in HIV-negative volunteers at enrolment.
The finding raises concerns about further bone mineral loss, which has been associated with tenofovir use in some studies (a rare side effect)
However, Lynn Paxton, noting that the ‘normal’ levels against which the findings were calibrated were taken from those in young American adults, said that these levels might simply be invalid for African populations.
What happens in Phase III clinical trial?
Testing of drug on patients to assess efficacy and safety.
Uses a therapeutic dose.
1000-2000
Determines a drug’s therapeutic effect at this point, the drug is presumed to have some effect.
Outline 6 Problems following a fall.
- Psychological problem
-Fear of falling and loss of confidence in being able to move about safely - Loss of mobility, leading to social isolation and depression
- Increase in dependency and disability
- Hypothermia
- Pressure-related injury
- Infection
Outline ways of Preventing Falls in old people.
Objective is to reduce the number of falls and their impact by:
- Prevention – including the prevention and treatment of osteoporosis.
ensuring that patients and their caretakers receive advice on prevention, through a specialized falls service. - Improving the diagnosis, care, and treatment of those who have fallen.
- Improving rehabilitation and long-term support
- Ensuring that older people who have fallen receive effective treatment and rehabilitation
Outline Prevention of osteoporosis
-Nutrition
-Physical exercise
-Pharmacological interventions
NUTRITION
There is a high prevalence of calcium, protein and vitamin D insufficiency in the elderly.
Vitamin D supplements can reduce the risk of falling provided the daily dose of vitamin D is greater than 700IU.
Calcium and vitamin D supplements decrease secondary hyperparathyroidism and reduce the risk of proximal femur fracture
Intakes of at least 1,000mg/day of calcium, 800IU of vitamin D and of 1g/kg body weight of protein can be recommended in the general management of patients with osteoporosis
Sufficient protein intakes are necessary to maintain the function of the musculoskeletal system
They also decrease the complications that occur after an osteoporotic fracture.
Correction of poor protein nutrition in patients with a recent hip fracture has been shown to lower occurrence of bedsores, severe anaemia, intercurrent lung or renal infection.
The duration of hospital stay of elderly patients with hip fracture can thus be shortened
- Physical Exercise
Maintaining bone strength and avoiding immobilization
Preferably weight bearing exercise.
Resistive exercises (reasonable weight lifting)
Smoking and excess alcohol intake linked to decreased BMD
CLINICAL INTERVENTIONS
Opportunistic screening of post-menopausal women attending family practices
focus more on risk of falling rather than on osteoporosis as indicated above
Dual Emission X-Ray Absorptiometry (DEXA) scans
Pharmacological interventions
Outline Health promotion approaches in relation to osteroporosis.
Similar to other lifestyle initiatives – nutrition, physical exercise, smoking cessation, alcohol moderation
Older people can be fiercely independent and not take up advice!
Special considerations:
lower mobility so access to health facilities may be difficult
under-nutrition special problem for elderly especially if living at home.
Need for good neighbours popping in, going for walks
personal alarms to call for help
Outline Hierarchy of evidence in relation to fall prevention.
I- meta-analysis of RCTs or 1 RCT
II- at least 1 non-randomised controlled study or quasi-experimental study
III- Evidence from non-experimental descriptive studies, such as comparative studies, correlation studies and case–control studies
IV- Evidence from expert committee reports or opinions and/or clinical experience of respected authorities
Outline Interventions that cannot be recommended for fall prevention.
Brisk walking
Low intensity exercise combined with incontinence programmes
Group exercise (untargeted)
Cognitive/behavioural interventions
Hip protectors
