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Geriatric Syndromes Flashcards

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1
Q

Define geriatric syndromes

A

Common health conditions in older adults that have multifactorial causes and do not fit into discrete disease categories

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2
Q

What are the implications of geriatric syndromes?

A

Predispose older adults to poor health outcomes, ↓ function and quality of life

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3
Q

What are some examples of geriatric syndromes?

A

Falls
Frailty
Cognitive impairment
Delirium
Urinary Incontinence
Iatrogenesis (including polypharmacy)

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4
Q

WHO Definition of Falls

A

An event which results in a person coming to rest inadvertently on the ground or other lower level

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5
Q

Best preictor of falls in geriatrics. Risk of falls?

A

Best predictor of future falls = having a previous fall

Risk of falls ↑ with age

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6
Q

What is the best predictor of future falls?

A

Best predictor of future falls = having a previous fall

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7
Q

Is there a difference in risk of falls between the sexes in geriatrics?

A

Females are at an increased risk compared to males

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8
Q

What are the implications of falls regarding geriatric patients health and quality of life?

A

Most common mechanism of injury causing death in older adults
#1 cause of traumatic hospitalizations/non-fatal injuries in older adults

5-10% of falls result in serious injury:
Bone fractures
Head injury
Laceration

Account for 95% of hip fractures in older adults
20% of those who suffer a hip fracture die within a year
Another 20% will never live independently again

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9
Q

What is a syndrome that may develop from increased fall risk in geriatric patients? Consequences?

A

Fear of falling syndrome

When individuals restrict their activities due to the fear of falling

Activity avoidance –> deconditioning –> ↑ fall risk

Also leads to social isolation, low mood, decreased quality of life (QoL)

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10
Q

What are some risk factors for falls?

A

Medical/Biological

Pharmacological

Environmental

Social/Economic

Behavioural

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11
Q

What are some medical and biological risk factors for falls?

A

Deconditioning
–> ↓ muscle strength, ↓ balance, poor gait pattern

Vision impairment

Hearing Impairment

Orthostatic hypotension

Heart rate or rhythm abnormalities

Dizziness/syncope

Pain

Neuropathy

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12
Q

What are some medical conditions that may contribute to falls?

A

Medical conditions
–> Dementia, Parkinson’s disease, previous strokes, depression, diabetes

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13
Q

Risk of Falls and Medical Conditions RAte

A

–> Risk of falling is at least 2x higher in older adults with ≥ 4 chronic conditions1

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14
Q

What are some environmental risk factors for falls?

A

Home hazards
Clutter, pets, throw rugs, lighting, lack of handrails or other supports

Community hazards
Snow/ice, uneven pavement, curbs, potholes, slippery floors, obstacles or tripping hazards

Lack of familiarity with surroundings

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15
Q

What are some social/economic risk factors for falls?

A

Social isolation
Living alone
Lack of community or family supports
Lack of transportation
Low income

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16
Q

What is the risk of social isolation?

A

Social isolation has the same mortality and risk factors as smoking a pack of cigarettes a day.

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17
Q

What are some behavioural risk factors for falls?

A

Improper footwear choices
Rushing
Impulsivity/risk-taking
Fear of falling/activity restriction
(Lack of) use of assistive devices
Alcohol use

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18
Q

What are some of the ways that drugs may contribute to falls?

A

Drugs can contribute to falls in many ways:

1) Cognitive changes (anticholinergic drugs, Z drugs)

2) Movement disorders (secondary Parkinsonism) –> Anti-psychotics (FGA higher risk), metoclopramide (DA blocking effect)

3) Gait and balance changes –> BZD’s, Anti-convulsants

4) Muscles weakness

5) Dizziness, drowsiness

6) Vision changes –> Eye ointments, anticholinergics

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19
Q

Are drugs contribution to falls a direct consequence? WHy or Why not? Examples?

A

May also contribute indirectly:

Example: diuretic –> urinary urgency/frequency –> fall rushing to the bathroom

Polypharmacy (4+ concurrent medications) = ↑ fall risk

Absence of appropriate drug therapy may also ↑ fall risk indirectly
Example: lack of appropriate treatment for pain or COPD –> ↓ activity tolerance –> ↑ fall risk

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20
Q

Why should medications be evaluated in the context of falls?

A

Medication are an important, potentially modifiable risk factor for falls

Numerous fall-risk increasing drugs (FRIDs)
–> Try to minimize exposure as much as possible

Studies have shown withdrawal of FRIDs reduces fall risk by 50%1

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21
Q

What are some drug classes that increase one’s fall risk?

Study These Flashcards
A

BZD
Anti-psychotics
Antidepresants
Anticholinergic Medications
CV Medications
Hypoglycemics
Anti-convulsants
Opiods

22
Q

BZD Reasons for Increasing Fall Risk

Study These Flashcards
A

Muscle weakness, ↓ balance and coordination
Drowsiness, dizziness
Cognitive changes/confusion

23
Q

Anti-psychotic Examples and Reason for Increasing Fall Risk

Study These Flashcards
A

Typical (e.g., haloperidol, chlorpromazine)
Atypical (e.g., risperidone, quetiapine, olanzapine)

Atypicals –> orthostatic hypotension

24
Q

Anti-depressants and fall risk examples

Study These Flashcards
A

SSRIs
SNRIs
TCAs
Trazodone
Others (“any antidepressant”)

SSRI’s cause the same risk of falls as TCA”s

25
What is a major consideration for BZD's, AP's and AD's fall risk increase?
Require a slow, gradual taper!
26
Anticholinergic Medication Risk of Falls
Effects of anticholinergic medications are cumulative
27
How can a pharmacist analyze fall-risk increasing medications?
Anticholinergic Burden Scale Reducing anticholinergic burden
28
CV Medications and Fall Risk Example and Reason
Digoxin, Type I antiarrhythmic medication (e.g., procainamide, disopyramide) associated with ↑ risk Data for antihypertensive medications is mixed --> Monitoring BP, including postural vitals is important --> Must weigh benefits of BP treatment with potential risks and adjust accordingly
29
Hypoglycemics and Fall Risk Example and Reason
Hypoglycemia ↑↑ fall risk in older adults Insulin has also been associated with ↑ fall risk --> Hypoglycemia --> Insulin is usually used in individuals with more advanced diabetes – may also have neuropathy, retinopathy which further compound fall risk Other diabetes medications that cause hypoglycemia also have the potential to ↑ fall risk Sulfonureas --> Do not sulfonureas as cause hypoglycemia Repaglinide --> Insulin secretion effect; contributes to hypoglycemia and falls
30
Anticonvulsants and fall risk examples and reason
Most data on ↑ fall risk with phenytoin, carbamazepine, and barbiturates No comparative studies with newer anticonvulsants (e.g., lamotrigine, levetiracetam, pregabalin) Meta-analyses analyzing anticonvulsants – any exposure ↑ risk
31
Opiods and Fall Risks Evidence
Studies show mixed results Data is conflicting so it’s important to weigh the risk vs benefit of opioid use for each patient (e.g., pain control vs fall risk)
32
What is a way to assess fall risk? What is a major consideration in this assesment?
Multifactorial falls risk assessment recommended for: Individuals that have fallen 2+ times in the past 12 months After an acute fall Gait or balance difficulties Falls generally have multifactorial causes – interventions should be multifactorial as well
33
What are some examples of multifactorial interventions for fall prevention ?
Vitamin D Evidence is mixed; some studies and meta-analyses have shown ↓ fall risk with vitamin D supplementation (particularly in those with vitamin D levels) Low-risk, low-cost Fracture Prevention Will not help prevent falls, but assessment and treatment for osteoporosis may help decrease fractures from falls Particularly hip fractures
34
Define frailty
Medical syndrome that increases an individual’s vulnerability to loss of independence and/or death
35
How can frailty be characterized? Who is it more likely in?
Characterized by decreased strength, endurance and functional reserves --> ↑ vulnerability to stressors Associated with ↑ age, ↑ number of medical comorbidities, women > men, ↓ socioeconomic status
36
Is there a specific tool to identify frailty?
No universally-agreed-upon tool to identify who is “frail”
37
What is the best predictor of frailty?
Best single-item predictor for frailty = gait speed Predicts functional decline and mortality Gait speed < 0.8 m/s (usually measured over 20m) correlates with frailty
38
Describe the relationship between frailty and medications
Medication adverse effects may contribute to frailty Medication --> nausea/GI upset --> ↓ appetite and weight loss --> Compounding muscle loss Medication --> fatigue --> ↓ activity --> deconditioning ------- Frailty also associated with ↑ risk of adverse drug reactions --> Particularly for those on 5+ medications!
39
How can fralty be managed?
Multifactorial causes --> multifactorial approaches Comprehensive geriatric assessment Exercise programs Aerobic, balance, and strength training Optimize health status Treat underlying conditions as per goals of care Streamline medications as much as possible
40
Describe number of medications and some specific implications in: 1) falls 2) cognitive imapirment 3) functional status 4). nutrition
41
Anti[psychotic Syndromes
Cogntive imapirment Falls UI Depression
42
Antidepressnat Syndromes
Delirium Coigntive IMpairment Falls Unintentional weight Loss/Appetite Loss UI
43
Anti-epileptics Syndromes
Delirium Coigntive IMpairment Falls Unintentional weight Loss/Appetite Loss UI Depression
44
BZD Syndro,mes
Delirium Cognitiove IMpairment Falls
45
Hypnotic Syndromes
Delirium Cognitiove IMpairment Falls
46
Opiod Syndropmes
Delirium Cognitivbe iMpairment Falls UI Depressionm
47
Anti-HTN Syndromes
Falls UI Depression
48
Anti-arrthymic Sybndromes
Delirium Cognitiove IMpairment Falls
49
Antidiabetes Syndromes
Falls Unintentional Weight Loss/Appetite Loss
50
Anticholinergic Syndromes
Delirium Cogntive IMopairment Falls UI

Geriatrics (6 decks)

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