Flashcards in 10: Falls and Polypharmacy Deck (60):
_____ and _____ are most cited as etiologies in falls with analgesics.
Psychotropics and CV agents
Average elder fills _____ prescriptions per year.
_____ of those who lie on the floor for more than 1 hour after fall die within 6 months of fall regardless of injury.
Concurrent use of multiple medications.
Extrinsic factors for falls (8).
1. Environmental hazards
2. Home situations: Lighting
4. Uneven surfaces
5. Old, unstable furniture
6. Low beds
8. Ground frost/ice
NSAIDs: Some authors recommend concurrent use of _____ to prevent side effects.
Regarding SSRIs: _____ can be very pronounced in some elders.
GI side effects
T/F The "Get-Up and Go" test helps identify people who may be at risk for falls.
True. Measures gait and balance. However, the issue of polypharmacy must be added to the testing.
What 2 fall risk factors emerged in a London study?
2. Living in shelters/long-term care settings
What 2 fall features are found to be most predictive?
1. Not being able to get up after a fall.
2. Previous overall functional decline.
Concerns with CCBs usually arise when coadministered with what 2 meds?
Risk factors for falls (6).
1. Hx of falls
2. Cognitive impairments
3. Visual impairments
4. Gait/balance disorders (Parkinson's, dementia, DM)
5. Lower extremity dysfunction
6. Psychotropic meds
7 rules for geriatric prescribing.
1. Start slow and increase slowly.
2. Remember the half-life of many drugs is prolonged in the elderly.
3. Increase doses slowly since it may take longer to reach a steady state.
4. Use the fewest number of drugs possible.
5. Watch for toxicity.
6. Remember adverse drug events may be manifested atypically in the elderly.
7. Know that CNS changes may be a marker for toxicity.
Regarding SSRIs: _____ can increase agitation in some elders.
T/F Use caution in tapering dosage of SSRI d/t risk of discontinuation syndrome.
These are most frequently used for angina, migraines, dysrhythmia, HTN.
When does warfarin peak?
Shows effect on PT in 2-3 days, but takes 7-10 days to peak.
T/F Important to consider OTCs in all medical histories. Aspirin, acetaminophen, and antihistamines most commonly used.
True. Laxatives and antacids are also common categories.
T/F Narcotic choices often underutilized in the elderly.
True (such as Tylenol with codeine).
What percentage of hip fractures die within 1 year if the fall occurred in a nursing home?
50% (and 4% of falls in nursing homes result in hip fractures).
Underprescribing often occurs in these 7 categories.
2. ACE inhibitors
Major pathway for excretion of this OTC drug is renal.
If you put a patient on digoxin, what are 3 meds that could interact?
Why are elders more susceptible to drug adverse effects (2)?
1. Age-related changes in homeostasis, pharmacokinetics
2. Number of drugs consumed (10 drugs = 100% chance of ADR)
T/F There are many interventions of unknown effectiveness that may work to reduce falls.
True. Group delivered exercise programs, nutritional supplementation, gait and balance training (can be very effective). However, interventions focusing on only one exercise category do not reduce falls.
5 factors affecting polypharmacy.
1. Multiple disease states
2. Multiple providers
3. Setting changes
4. Minimal access to primary care
5. Sensory deficits leading to nonadherence/confusion regarding medical plan
T/F Fear of falling is its own risk factor.
True. Activity limited after a fall due to fear of falling again. Lack of activity puts person more at risk for falls. Highly ranked amongst community dwelling elders as major fear.
T/F Adverse reactions to meds can be mistaken for age-related changes or manifestations of disease.
What percent of hip fractures die within 1 year?
15% (and 1% of falls result in hip fractures).
T/F CNS changes may be a marker for drug toxicity in the elderly.
Regarding SSRIs: _____ can very sedating.
Serotenergic enhancers can cause serotonin syndrome when added to SSRIs. Which ones are the most likely causative agents (3)?
2. St. John's Wort
Which med is associated with high hospitalization rates?
What meds does warfarin interact with (5)?
_____ have generally been safer antidepressants than older TCAs.
T/F Approximately 50% of older adults in LTC will suffer a fall within a year. 10% of these result in serious injury.
Consultation services in LTC can help reduce falls by targeting suboptimal practices. Who benefits the most?
Patients with 3+ falls.
Linked to falls in the elderly. Most frequently prescribed medication class worldwide.
_____ of hospital admissions for elders are the result of falls.
T/F Drug blood levels are a good objective measure for the elderly.
False. Drug levels are not as reliable measures as people get older. Age-related changes make it difficult to determine whether medication is bound or not bound.
T/F Falls present an increased risk of nursing home admission.
Verapamil and diltiazem are potent inhibitors of the _____ system.
Intrinsic factors for falls (4).
1. Physiological and pathological etiologies.
2. Drug toxicity.
3. Psychological factors (depression, anxiety).
4. Nutritional concerns.
What are the 5 risk factors in depression that increase falls?
1. Poor self-rated health.
2. Poor cognitive status.
3. Impaired ADLs.
4. 2 or more clinic visits/year.
5. Slow walking speed.
T/F Footwear is a major factor in falls.
T/F Elders in nursing homes have 3x the rate of falls as community-dwelling elders.
Adults _____ yo have side effects 2–3x more frequently than younger adults.
What are age-related changes that can contribute to fall risks (5)?
1. Proximal muscles more reactive than distal ones.
2. Center of mass returns to normal less efficiently.
3. Lower extremity muscle weakness
4. Changes in vision.
5. Changes in postural sway/balance.
T/F Risk of falls increase with the number of chronic illnesses.
True. Even more at risk coupled with functional deficits.
Cause high rates of hyperkalemia in the elderly.
T/F Questions should be asked about history of falls on a yearly basis.
Due to high incidences of adverse drug reactions, lower doses in the following are often helpful in enhancing compliance and efficacy (3).
1. ACE inhibitors
3. Antidepressant medication
When do you consider a PT referral (5)?
1. Increased grabbing of furniture
2. Major change in function
3. Recent illness
4. Hospitalization or surgery
5. Change in environment
For postfall assessment and intervention, the DROPP mnemonic can be helpful. What is it?
D = Diseases/drugs
R = Recovery
O = Onset
P = Prodrome
P = Precipitants
Also must consider:
-If unconscious, consider syncopal workup.
-If lightheaded, consider CV, ortostasis, drugs, anxiety, depression.
-For true vertigo, consider BPV, labyrinthitis, Meniere's.
-For gait disorder, patient may have problem with imbalance and lack of proprioception.
-Goal should be no more than four medications administered, and all should be reviewed.
-Alcohol should not be consumed.
-Underlying illness or disability should be treated.
-Undiagnosed illnesses must be identified.
In the elderly, which NSAIDs should be avoided (4)?
T/F Safer choices for analgesia include acetaminophen.
What is a huge concern with digoxin in the elderly?
It has a very narrow therapeutic window. Can quickly and easily become toxic to patients.
_____ of adults leave PCP with a prescription.
What fall interventions are most likely to be beneficial (5)?
1. Environmental risk reduction with multidisciplinary team
2. Cognitive behavioral therapy
3. Home hazard modification
4. Withdrawal of psychotropics
5. Tai chi