Falls + old age

Question 1

Advantages of admitting an older person to hospital

Answer 1

Specialised care if condition is bad
Continuous monitoring of health
Allows time for at-home care to be arranged
Regular monitoring

Question 2

Disadvantages of admitting older person to hospital

Answer 2

Decline in physical ability
Possibility of contracting hospital-acquired infections
Increased risk of delirium
Expensive

Question 3

Advantages of at-home care for an older person

Answer 3

No interruption to relationship between patient and caregivers
Familiar surroundings
Reduction in risks associated with hospital admission

Question 4

Disadvantages of at-home care for an older person

Answer 4

Delay in care for emergencies

Varied standards of care - dependent on skills of caregiver

Question 5

What are the 4 main causes of falls?

Answer 5

accident
disease
poison
environmental factors

Question 6

What is the effect of ageing on eyesight?

Answer 6

Decreased acuity
Decreased contrast sensitivity
Decreased dark adaptation
Decreased depth perception

Question 7

What is the effect of ageing on the brain?

Answer 7

Fewer neurones
Fewer nerve fibres
Slower reaction times
Impaired integration of sensory information (less able to cope with conflicting info)

Question 8

What is the effect of ageing on muscle?

Answer 8

Decreased muscle mass
Decreased muscle strength
Slower contraction
‘Active’ muscle ages less = vocal muscles, physically active elderly

Question 9

Which drugs can cause falls?

Answer 9

Psychotropics + sedatives
Blood pressure lowering agents
Polypharmacy (>4 medications)
Sleeping tablets
Centrally-acting analgesics (eg. opioids)
Sedatives for anxiety
Blood pressure treatment 
Muscle relaxants
Alcohol

Question 10

What are some environmental causes of falls?

Answer 10

Slippery surfaces
Trailing wires
Loose carpets
Poor lighting
Cluttered stairs
Pets
Risk-taking

Question 11

How does an occupational therapist help a falls patient?

Answer 11

Home assessment - suggest adjustments in home environment to reduce risk of falls
Assess for need for walking aids and ensure patient is competent using them if required
Hip protectors/fall alarms for patients at high risk

Question 12

How does a physiotherapist help a falls patient?

Answer 12

Help improve mobility issues so the patient is more stable on their feet

Question 13

How does a doctor help falls patients?

Answer 13

Reducing polypharmacy
Review medications
Assess and manage bone health in older patients
Check lying and standing blood pressure in patients at high risk of falls

Question 14

What constitutes a high risk faller?

Answer 14

Fall in previous 12 months
Fall with injury
Cognitive impairment
Visual impairment
Gait/balance disturbance 
Fear of falling
Leaving rehab setting (particularly following NOF#)

Question 15

What is the purpose of a home assessment?

Answer 15

Identify home hazards + recommend/arrange modifications
Assess + modify performance + function
Identify + agree strategies to reduce falls risk
Education + information giving

Question 16

What are some potential home accommodations for a falls patient?

Answer 16

Extra hand rails
Ensuring heating is present and they can afford it
Advice around clothes/shoes (not trailing on floor, good grip)
Marking edge of steps with white paint (so it is in contrast and easier to see)
Walking aids
Falls alarm

Question 17

How does body composition change with age?

Answer 17

Fat = larger proportion of body mass in elderly (reduced lean body mass)
Change in volume of distribution of drug (volume of distribution = drugs distribute within the body, changes in relative % of fat + lean tissue change this distribution)

Question 18

What effect does ageing have on the kidneys? How does this affect drug clearance?

Answer 18

GFR (glomerular filtration rate) decreases from ~20 years of age:
Many drugs eliminated by the kidneys
Less effective elimination = greater + prolonged effect

Question 19

Define polypharmacy

Answer 19

taking >= 4 medications

Question 20

How can drug interaction issues be minimised in elderly patients?

Answer 20

accurate drug history --> why on it? still need it?
priority to non-drug alternatives
ask patients about side effects
use lowest dose for shortest time
close monitoring