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Geriatric falls a case discussion for pharmacy undergraduates

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Geriatric falls a case discussion for pharmacy undergraduates

  1. 1. Case Discussion for Pharmacy Undergraduates Geriatric Falls By, Dr. Lokesh Shetty MPHARM – Pharmacology Lecturer - RCsDP
  2. 2. Falls in Geriatrics
  3. 3. Falls: Mrs. F. Mrs. F. is an 80 year old woman who lives alone. She just came in to your office for follow up of a fall resulting in a Colles’ fracture (fracture of the distal radius in the forearm). She has had two other falls over the past year. She is scared of falling again. She has a history of osteoarthritis and anxiety/ depression. She is on naproxen 500mg BID and diazepam 5mg BID when necessary.
  4. 4. Overview Prevalence Clinical Importance Risk Factors & Etiology Evaluation Prevention & Management Falls & restraint use Summary
  5. 5. Prevalence 30% of those over the age of 65 fall annually Half are repeat fallers Falls go up with each decade of life as inclining age
  6. 6. 1% of falls result in hip fractureImpact of Hip Fractures  25% die within 6 months 60% have restricted mobility 25% remain functionally more dependent
  7. 7. Falls Causes  Mortality (death) Fractures: 6% of falls Soft tissue injury, head injury etc Fear of falling can result in  decreased activity, isolation, and further functional decline Nursing home placement and loss of independence
  8. 8. Falls are Multifactorial Intrinsic Factors Extrinsic FactorsMedical MedicationsconditionsImpaired visionand hearing Improper use of FALLS assistive devicesAge relatedchanges Environment
  9. 9. Normal Changes with Aging Neurologic  Increased reaction time  Decreased righting reflexes (regain back former body position) Vision Changes  Decreased accommodation & dark adaptation Decreased muscle mass Old Age Slower gait (manner in which human or animal moves using limbs) Falls
  10. 10. Risk Factors for Falls Risk Factor  Sedative use  Cognitive Impairment  Lower extremity problem  Pathologic Reflex  Foot Problems  gait problems
  11. 11. Common Pathologies associated with Falls Ophthalmologic diseases Arthritis Foot problems Neurologic illness  Parkinson’s & related disorders  Strokes  Peripheral neuropathy Dizziness and disequilibrium
  12. 12. Medications and Falls Sedative-hypnotics, especially long acting benzodiazepines, increase falls Small association between most psychotropics and falls SSRIs and TCAs both incrsease falls Weak association between Type 1A antiarrythmics, digoxin, diuretics, and falls
  13. 13. Evaluation of Falls: History Location & circumstances of Fall Associated symptoms Other falls or near falls Medications (including nonprescription) and alcohol Injury & ability to get up
  14. 14. Evaluation of Falls: Physical Examination Supine and standing BP - always Routine physical examination  Focus on cardiovascular, MS, neuro, feet Vision and hearing evaluation Consider acute medical illness & delirium Formal gait and balance assessment
  15. 15. Evaluation of Falls: Home Evaluation Can be performed by nurse or others ? Reason for fallEvaluation of Falls: Risk Factors Assessment
  16. 16. Common Causes of Abnormal Gait Difficulty arising from chair Weakness Arthritis Instability on first standing Hypotension, Weakness Instability with eyes closed Proprioception Step height/length Parkinsonism Frontal lobe Fear
  17. 17. Prevention & Treatment Treat acute injury & underlying medical conditions Remove unnecessary medications Rehabitation, exercises, assistive devices Correct sensory impairments Environmental modifications & safety Evaluate for osteoporosis treatment
  18. 18. Osteoporosis  Calcium and vitamin D for most elders at risk  Osteoporosis evaluation and treatment  Hip protectors appear to protect from hip fractures in those who wear them  Thiazides may help slightly  Statins?
  19. 19. Risk Factor Modifications for Fractures Quit smoking Treat impaired vision Stop sedatives Add 1 Gram Calcium Hip Protectors
  20. 20. Falls: Primary Prevention Intervention: adjustment in medications, behavioral instructions, exercise programs aimed at modifying risk factors One year follow up
  21. 21. Restraint (Restriction to movement)Reduction and Injury No evidence that restraints reduce fall injuries Restraints increase morbidity and may cause death Risk factor for delirium, malnutrition, aspiration pneumonia
  22. 22. Alternatives to Restraints for PatientsWho Fall or Wander  Accept the risk of falling  Hip protectors  Environmental modifications, day rooms, low beds  Least restrictive alternatives  Alarms  Sitters or family  Geriatric consultation team
  23. 23. Summary Falls are common in the elderly & may lead to injuries and decline in function Evaluation should included risk factor assessment, gait assessment, and home assessment Exercise can improve outcomes We have no evidence that restraints reduce fall related injuries

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