How can older adults prevent falls? Older adults can remain independent and reduce their chances of falling. They can:
Exercise regularly. It is important that the exercises focus on increasing leg strength and improving balance, and that they get more challenging over time. Tai Chi programs are especially good. Ask their doctor or pharmacist to review their medicines—both prescription and over-the counter—to identify medicines that may cause side effects or interactions such as dizziness or drowsiness. Have their eyes checked by an eye doctor at least once a year and update their eyeglasses to maximize their vision. Consider getting a pair with single vision distance lenses for some activities such as walking outside. Make their homes safer by reducing tripping hazards, adding grab bars inside and outside the tub or shower and next to the toilet, adding railings on both sides of stairways and improving the lighting in their homes.
To lower their hip fracture risk, older adults can:
Get adequate calcium and vitamin D—from food and/or from supplements. Do weight bearing exercise. Get screened and, if needed, treated for osteoporosis.
Measures to reduce fall risk 1. Minimize risk of falls with gait and balance training 2. Adjust dosage of drugs with sedative effects, which could slow reflexes, decrease coordination, and impair the patient’s ability to break the impact of fall 3. Anchor rugs 4. Minimizes clutter 5. Remove loose wires 6. Use non-skid mats 7. Install handrails in bathrooms, halls, and along stairways 8. Light hallways, stairwell and entrances 9. Encourage patient to wear study, low-heeled shoes 10. Hip protectors (in patients predisposed to falling)
THE ELDERLY CARE
General principles of geriatric care As individual age, they are more likely to suffer from disease, disability and treatment side effects. The health problems and medical management of elderly patients differ from those of younger ones in important ways. The chief differences in disease manifestations, and opportunities for treatments are described below: 1.Atypical disease prevention Often in elderly. A disorder in one organ system may lead to symptoms in another, especially one compromised by pre-existing disease. Because these organs systems are often in the brain, the lower urinary tract or the CVS or musculoskeletal system, a limited number of presenting symptoms predominate- confusion, falling, incontinence, functional decline, and syncope- irrespective of the underlying disease. 2. Earlier presentation because of impaired compensatory mechanisms a) b) c) Urinary retention may be precipitate by only mild prostatic enlargement Non-ketotic hyperosmolar coma by only mild glucose intolerance Drugs side effects can occur with low doses of drugs that usually produce no side effects in younger people
3. Therapeutic goals may shift from cure to care Although some of the elderly may seek a focus on life extension, others clearly want emphasis on improved function, comfort and quality of life. Approach to the older patient 1.Patient’s preference, goals and priorities An effective therapeutic encounter calls for a clear understanding of the patient’s preferences and goals. The patient’s goal for care, life expectancy, the prevalence of specific diseases, the performance of screening or diagnostic tests and the effectiveness of therapeutic intervention will shape the priorities of care for a particular elderly patient. Thus, the priorities for the elderly are likely to differ from those of younger people. 2. Caregiver issues Providing primary care for a frail elderly person requires attention to the caregivers as well as the patient, as the health and well-being of the two are closely linked. Direct questions to the caregiver about stress, burnout, anger and guilt are often productive. For the stress caregiver, a social worker may help identify programs such as caregiver support groups. The caregiver who is at risk for depression should be screened for it.
Home environment assessment The main objectives: 1) 2) 3) 4) To understand the home environment of the elderly and home hazards To see the interaction between the elderly’s functional abilities and the home environment To see how care can be optimized taking into considerations the home situation To detect any potential hazards that may predisposed the elderly to falls
The principles of rational prescribing Polypharmacy may be defined as the prescription, administration or use of more medications that are clinically indicated. Other definitions include a medical regimen that includes at least one unnecessary medication, or the empiric use of five or more medications. 10 steps to reduce polypharmacy 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Keep an accurate record of all medications the patient is on, including over the counter medications Get into the habit of identifying all drugs by generic name and drug class Make certain that each drug being prescribed has a clinical indication Know the side-effect profile of the drugs being prescribed Understand how pharmacokinetics and pharmacodynamics of aging increase the risk of adverse drug events Keep an accurate record of all medications the patient is on, including OTC medications. Get into the habit of identifying all drugs by generic name and drug class Make certain that each drug being prescribed has a clinical indication Know the side effects of the drugs being prescribed Understand how pharmacokinetics and pharmacodynamics of aging increase the risk of adverse drug events.