Falls in t he Elderly Dr J ane Youde Falls in t he Elderly Falls - - PowerPoint PPT Presentation

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Falls in t he Elderly Dr J ane Youde Falls in t he Elderly Falls - - PowerPoint PPT Presentation

Nov 21, 2023 269 likes •852 views

Falls in t he Elderly Dr J ane Youde Falls in t he Elderly Falls in t he Elderly Falls in the elderly are best avoided David Barker 2003 Conc ept s Why best prevented? Why do older people fall? Can we stop falls? Aim

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Falls in t he Elderly

Dr J ane Youde

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Falls in t he Elderly

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Falls in t he Elderly

“ Falls in the elderly are best

avoided” –David Barker 2003

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Conc ept s Why best prevented? Why do older people fall? Can we stop falls?

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Aim s

To summarise the epidemiology of falls in the elderly To introduce concepts regarding the consequences, causes, assessment and prevention of falls in older people

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Falls and Sync ope in Older People

Fall: An event which results in a person coming to rest inadvertently at a lower level

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Falls and Sync ope in Older People

Syncope: A transient loss of consciousness, characterised by unresponsiveness and loss of postural tone with spontaneous recovery

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Census Inform at ion

A fifth of the population is > 60 years old Between 1995 and 2025 the number of people

  • ver the age of 80 is set to increase by almost a

half and the number of people over 90 will double.

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Census Inform at ion

The NHS spent around 40% (10 billion) of its budget on people over the age of 65 in1998/99. In the same year social services spent nearly 50% of their budget on the over 65s (5.2 billion) Approximately 66% of general and acute hospital beds are used by people over 65

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Falls in t he Elderly

Important cause of morbidity and mortality in the elderly In 1 year 33% of people >65 years have 1 fall Commonest presenting complaint to A&E in patients >65 years (400,000 patients/year)

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Falls in t he Elderly

20% 1 year mortality in people who have a fractured neck of femur (# NOF) Total Cost to the UK/year for care of # NOF is £1.7 billion

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Falls In t he Elderly

Cost of falls 45% for acute care 50% social/long term care 5% drugs/follow up

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Falls in t he Elderly

Recent evidence suggests fear of falling and the associated effect on health has a significant adverse effect on quality of life One of the Government’s health improvement targets is reducing mortality from accidents

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Falls in t he Elderly

30% of cognitively intact older people are unable to recall documented falls 3 months after the event Eye witness accounts of falls are often unavailable Amnesia for a loss of consciousness is present in up to 50% of patients with syncope

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Falls and Sync ope in Older People

Integrated falls clinics: Up to 75% had a evidence of a cardiovascular cause of a fall/syncope/dizziness At least 25% had amnesia for syncope despite this being witnessed during carotid sinus massage

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Consequenc es of Falls

Trauma Soft Tissues Injuries Fractures and dislocations: Humerus, pelvic ramus, clavicle, femur

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Consequenc es of Falls

“Long Lies” Hypostatic pneumonia Pressure Sores Dehydration Hypothermia

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Consequenc es of Falls

Psychological “Fear of Falling”

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Causes of Falls

NSF for Older People Defines These

MULTI-FACTORIAL

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Causes of Falls

Associated with physiological ageing

E.g. impaired response times, impaired muscular strength

Multi-factorial Multi-disciplinary

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Int rinsic Fac t ors

Balance and Gait > 4 medications Visual impairment Cognitive problems Postural hypotension and Cardiovascular causes

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Int rinsic Fac t ors

Gait and Balance Stroke Disease Parkinsonism Arthritic Changes Neuropathy Muscle Disease Vestibular Disease

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Int rinsic Fac t ors

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Int rinsic Fac t ors

Medications Polypharmacy is common in older people Sedatives significantly increase the risk of falling Cardiovascular medications can contribute towards falls Medication is often incorrectly used

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Adverse Drug Reac t ions

Common in older people Risk increases with the number of medications prescribed Average number of medications taken by nursing home residents is 7

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ADRs

66% of admissions with ADRs are over the age of 60 years Accounts for 3.4-16.6% of acute admissions Associated with 8-10% mortality

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Beers Crit eria

In the USA used to define medication to avoid using in the elderly, use with caution

  • r will exacerbate pre-existing syndromes

27% of ADRs in the community and 42%

  • f ADRs in NH/RH are preventable
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Beers Crit eria

In USA cost $7.2 billion If taking medication on the Beers lists there is an association with increased ADRs, hospitalisation and mortality Used for Quality monitoring

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Beers Crit eria

Medications to avoid: Chlorphenaramine Alpha-blockers Methyldopa NSAIDs Metoclopramide Benzodiazepines Amitryptiline

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Medic at ion

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Medic at ion List s

86% of admission drug lists had some form of discrepancy when cross-checked against GP prescription lists. 71% of individual prescriptions were discrepant. Cardiovascular and analgesic medications commonly differed. Pharmacists managed to check 67% of available patients medications.

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Medic at ion List s

 Of 64 patients who were able to list their medications,

  • nly 64% described the same list as admitting doctors

and only 43% described the same list as general practitioners.  Hospital doctor and general practitioner lists were the same in only 37% of cases.

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Falls

Benzodiazepines and psychotropic drugs are significantly associated with an increase in falls 10-12% of the older population are prescribed benzodiazepines with 80% on long term treatment (>2 years) Withdrawal of psychoactive drugs can result in a 66% reduction in falls

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Non Com plianc e

Non-compliance with medication is related to the number of medications taken Lack understanding of the medication Change in medication regieme e.g. hospital discharge Not all aids are suitable Unable to take the prescribed form of the drug

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Int rinsic Fac t ors

Cognitive Impairment Any form of dementia is associated with an increase in falls If the cognitive impairment is advanced these patient do not benefit from rehabilitation

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Int rinsic Fac t ors

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Int rinsic Fac t ors

Visual Impairment Common with increased age Bi-focals increase the risk of falling Glaucoma, macular degeneration and retinopathy increase the risk

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Cardiovasc ular Responses t o St anding

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Cardiovasc ular Causes of Falls in Older People Causes: Orthostatic Hypotension (OH) Postprandial Hypotension Carotid Sinus Syndrome Neurocardiogenic Syncope Arrhythmias Structural Heart Disease

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Ort host at ic Hypot ension

Defined as >20 mmHg fall in systolic blood pressure and/or a >10 mmHg fall in diastolic blood pressure within 3 minutes

  • f standing WITH symptoms
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Post prandial Hypot ension

Definition: A fall of  20 mmHg in Systolic blood pressure after the ingestion of a meal Can have effect for up to 90 minutes

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Carot id Sinus Syndrom e

Cardio-inhibitory 3 seconds of asytole produced by carotid massage Vasodepressor a fall in systolic blood pressure of >50 mmHg with no heart rate change Mixed

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Neuroc ardiogenic Sync ope

Vasodepressive Fall in systolic blood pressure to <80 mmHg with no change in heart rate Cardio-inhibitory Fall in heart rate to <40 Mixed

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Sync ope/Carot id Sinus Syndrom e

Review medication May need a pacemaker May need medication to stop falls in blood pressure

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Arrhyt hm ias

Consider if have palpitations prior to syncope or if sudden onset If 12 lead ECG is within normal limits a 24 hour tape will only be diagnostic in 2% of cases Can be due to excessively fast or slow heart rates (tachycardias/bradycardias) or both

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Valvular Disease

The incidence of calcific aortic stenosis (narrowing of the aortic heart valve) increases with age  Examination important Confirmed with echocardiogram Outcome for >80years old is good

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Ex t rinsic Fac t ors

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Ex t rinsic Fac t ors

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Ex t rinsic Fac t ors

Poor lighting Stairs Rugs/Floor surfaces Clothing/footwear Lack of equipment

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Ex t rinsic Fac t ors

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Ex t rinsic Fac t ors

Walking Aids Must be appropriate and maintained Should be educated on the safe use of them

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Falls in t he Elderly

Full history ?First fall/multiple falls Eye witness account Associated features Risk Factors for falling Drug History Alcohol Intake

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Falls in t he Elderly

Management Remember multi-factorial Review drug regime

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Falls in t he Elderly

Prevention Regular evidence based exercise Assessment and treatment for

  • steoporosis

Review especially to monitor medication and ongoing medical problems Environmental Issues

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Falls in Older People

Multifactorial Multidisciplinary Polypharmacy

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The End