Transcript An Interdisciplinary Approach to Older Adult Fall Prevention

AN INTERDISCIPLINARY APPROACH
TO OLDER ADULT FALL PREVENTION
April 15, 2015
Sponsored by
The Geriatrics and Gerontology Education and Research Program,
University of Maryland, Baltimore
The Johns Hopkins Geriatric Education Center Consortium
The Center for Injury and Sexual Assault Prevention, Department of
Health and Mental Hygiene
Presentations
• The Essentials of Preventing Falls in the Older Adult
Jessica Colburn, MD,
The Johns Hopkins School of Medicine and Hopkins Bayview Medical Center
• Falls Management in Older Adults: “The Double-Edged Sword”
Dennis Klima, PT PhD GCS NCS,
University of Maryland Eastern Shore
• Preventing Medication-Related Falls through Appropriate
Medication Use
Chanel Agness, PharmD, BCPS, CGP, FASCP and
Stephanie Callinan, PharmD
University of Maryland School of Pharmacy
Case Discussion
• History of Present Illness:
• Mr. Samuel is a 84 year old man who was recently
admitted to Sunnyside Nursing Facility after a recent
hospitalization due to dehydration.
• Patient was started on amlodipine, pantoprazole and
zolpidem during hospitalization.
• Patient complains of dizziness and lightheadedness
when getting up from a seated position. Also reports
that he gets up twice a night to use the bathroom.
• His Timed Up and Go (TUG) Score is 19 seconds. He
tends to shuffle his feet in gait. He complains of hip
pain and weakness.
Case Discussion
• He had a prior fall at home this past year and
was instructed to use a cane.
• He lives in a 3 story row home in East
Baltimore with his wife. His wife has what he
describes as some “forgetfulness”. He has a
small dog that he loves to walk in
neighborhood.
• His goal is to return home.
Past Medical History :
• Hypertension
• Osteoarthritis
• Benign Prostatic Hypertrophy
• Diabetes
Medications:
•
•
•
•
Aspirin 81 mg daily
Sliding Scale Insulin
Atenolol 100 mg twice daily
Oxycodone/Acetaminophen 5/325 mg three
times daily
• Terazosin 1 mg nightly at bedtime
• Zolpidem 10mg at bedtime
• Chlorpheniramine for occasional allergies
Vital Signs: (as found in chart)
• Sitting BP: 146/84 mmHg, pulse 76
• Standing BP: 130/70 mmHg, pulse 88
Questions
• Using Beer’s List, identify potentially inappropriate
medications that can increase risk for falls.
• Using 31 Tool, assess Mr. Samuel’s medication –related fall
risk.
• Recommend one strategy to decrease medication –related
fall risk AND to educate Mr. Samuel.
• What is potentially one intrinsic cause of falls which pertains
to his medical history and gait?
• What are some potential extrinsic risk factors that need to
be considered for him to go home?
Questions
• What are some potential mobility
interventions to decrease his fall risk?
• What should we do about assessing for his
vitamin D.