Falls prevention strategies
- MDT assessment
- Cataract surgery
- Specific strength & balance training by trained professionals
- Grasp & functional balance exercises
- Stop centrally acting drugs
- CVS assessment of unexplained fallers
- Comprehensive geriatric assessment in RH/NH
- Targeted intervention in hospitals
Define Osteoporosis
A progressive systemic skeletal disease characterised by low bone mass and micro architectural deterioration of bone tissue,with a consequent increase in bone fragility and susceptibility to fracture (WHO 1994)
Risk factors for osteoporosis
Age >65 years
Vertebral compression fracture Fragility fracture after age 40 years
Family history of osteoporotic fracture
Glucocorticoid therapy of >3 months
Malabsorption syndrome
Primary hyperthyroidism
Osteopenia apparent on radiograph Hypogonadism
Early menopause (before age 45 years)
Rheumatoid arthritis
Past history of clinical hyperthyroidism
Chronic anticonvulsant therapy
Low dietary calcium intake Smoker
Excessive alcohol intake BMI <19kg/m2
Weight loss >10% of weightat age 25 years
Long-term heparin therapy
Treatment options for osteoporosis
- Bisphosphonates
- Strontium
- Teriparatide
- Denosumab
Side effects of Bisphosphonates
- ONJ
- Atrial Fibrillation
- Atypical fractures
- Oesophageal Cancer
What is Frailty?
Frailty is a medical syndrome with multiple causes and contributors that is characterized by diminished strength, endurance, and reduced physiologic function that increases an individual’s vulnerability for developing increased dependency and/or death.
‘Living with frailty’ - 5 main syndromes:
• Falls (e.g. collapse, legs gave way, ‘found lying on floor’).
• Immobility (e.g. sudden change in mobility, ‘gone off legs’ ‘stuck in toilet’).
• Delirium (e.g. acute confusion, ’muddledness’, sudden worsening of confusion in someone with previous dementia or known memory loss).
• Incontinence (e.g. change in continence – new onset or worsening of urine or faecal incontinence).
• Susceptibility to side effects of medication (e.g. confusion with codeine, hypotension with
antidepressants).
Criteria of Phenotype model of frailty
- Unintentional weight loss
- Reduced muscle strength & Sarcopenia
- Reduce gait speed
- Self-reported exhaustion
- Reduce energy expenditure
- 3+ denote frailty
Predictive of poorer
Cumulative deficit model of frailty
- Loss of hearing, Low mood
* Tremor, Dementia
When can we look for frailty?
- Routine outpatient appointments in all departments, including surgical (orthopaedic, GI, vascular and ophthalmic departments), medical and mental health (memory clinics).
- Social services assessment for care and support.
- Review by the community care teams after referral for community intervention.
- Primary care review of older people (either medical intervention or medicines review or any other interaction such as one of the long term conditions clinics).
- Home carers in the community.
- Ambulance crews when called out after a fall or other urgent matter
Why do we need to identify frailty?
- To improve outcomes and avoid unnecessary harm
- Prevent hospital admission
- Maintain health and independence
- Provide person centred, goal orientated care & treatment
Most common reasons for admission to hospital for older adults
COPD CHF Angina Cellulitis Dehydration & gastroenteritis Iron Deficiency Anaemia
Components of Frailty assessment
- PRISMA 7
- Walking Speed
- Timed get up and Go
- Self –reported health
- GP clinical assessment
- Comprehensive Geriatric Assessment
- Polypharmacy >5
- Frailty Index Questionnaire
What is the Rockwood Clinical Frailty scale ?
Scale 1 to 9
1 very fit 2 well 3 manning well 4 vulnerable 5 mildly frail 6 moderately frail 7 diversely frail 8 very severely frail 9 terminally ill
