falls, old age physiology

Question 1

stochastic theory of ageing

Answer 1

cumulative damage, random

Question 2

programmed theory of ageing

Answer 2

predetermined, changes in gene expression

Question 3

frailty - 2 terms

Answer 3

susceptibility state:

redundancy: progressive accumulation of damage
dyshomeostgasis: breakdown of interplay between systems

Question 4

frailty syndromes

Answer 4

falls, immobility, delirium, functional loss

Question 5

decompensated frailty?

Answer 5

presents with repeated falls/insults to primary then secondary

aggressive self perpetuating problem

Question 6

CGA?

Answer 6

comprehensive geriatric assessment: MDT - goal centred + pt centred management plan

Question 7

Domains of CGA

Answer 7

nutritional
spiritual
psychological 
medical 
functional 
behavioural 
environmental 
social

Question 8

SEs of anticholinergics

Answer 8

confusion, dry mouth, constipation, postural hypotension, blurred vision

Question 9

SEs of benzodiazepines

Answer 9

falls confusion (CNS toxicity)

Question 10

SEs of digoxin

Answer 10

toxicity with normal serum concs

Question 11

2 drugs that have an altered effect on the elderly due to changes in pharmacokinetics

Answer 11

diazepam: increased sedation
warfarin: increased coagulation -falls, GI bleeds

Question 12

Effects of old age on absorption

Answer 12

decreased GI motility - delay in onset of action

Question 13

Effects of old age on distribution

Answer 13

increased adipose tissue (increased distribution of fat soluble drugs), reduced muscle mass

Question 14

Effects of old age on

metabolism

Answer 14

decreased liver mass+ flow - increased available drug - increased toxicity

Question 15

Effects of old age on

excretion

Answer 15

reduced renal function - increased drug 1/2 life. toxicity

Question 16

Assessing geriatric polypharmacy

Answer 16

lower doses, less frequent

start low go slow

review regularly

keep regimes simple

try deprescribing when reviewing

Question 17

intrinsic RFs for a fall

Answer 17

• gait + balance: via TUG (timed up and go test) - assessing vertigo, CNVIII, postural hypotension
• syncope / vagal or cardiac (arrhythmia)
• acute illness
• visual problems

Question 18

situational factors for a fall

Answer 18

meds
alcohol
urgency of micturition

Question 19

extrinsic RFs for a fall

Answer 19

obstacles - shoes, carpet etc

Question 20

Assessing pt whose fallen

Answer 20

1. assess + tx PC: e.g. # - ortho, UTI - urine dipstick
2. Ddx: dipstick, CT head, ECG (arrhythmias), BP (hypotension), confusion (4AT)
3. collateral hx
4. MDT CGA - their concerns
5. assess osteoporotic risk
6. aim to deprescribe