deprescribing, frailty and bone health

what are the consequences of problematic polypharmacy

• increased cost

• medicines waste

• prescribing cascade

• increased frailty, falls and mortality

what interventions address the consequence of polypharmacy

• medication reviews

• deprescribing tools

• STOPP/START tool

what are the adverse drug reactions associated with anticholinergics

• dry eyes

• urinary retention

• cognitive impairment

• increased falls risk

what is frailty

gradual decreased physiological reserve with increases vulnerability to stressors

what risk assessments can be used to assess frailty

• FRAIL scale

• Clinical frailty scale

• Comprehensive geriatric assessment

• geriatric G8 screening tool

what does the G8 screening tool assess

• age

• decline in food intake

• recent weight loss

• mobility level

• neuropsychological conditions

• BMI

• more than 3 prescription drugs daily

• self-rated health status

what are the common bone conditions in the elderly

• osteoporosis - low bone density

• osteomalacia - causes bone pain and muscle weakness

what is the pathophysiology of bone ageing

• decreased bone mass

• increased structural deterioration of bone tissue

• decreased bone formation and increased resorption

• reduced osteoblast activity

what is sarcopenia

age-related loss of muscle mass and functioning

what are the non-modifiable risk factors for poor bone health in the elderly

• age

• female

• family history

• white or Asian ethnicity

• previous fracture

what are the modifiable risk factors for poor bone health

• vitamin D and C deficiency

• sedentary lifestyle

• smoking

• alcohol

• low BMI

how does cancer effect bone health

• cancer and its treatment increase the risk of bone loss and skeletal complications

• the bone is the third most common site for metastasis

what are the mechanisms of bone involvement in cancer

• bone metastasis

• cancer cells disrupt the balance of osteoclast and osteoblast activity

• treatment related bone loss

• hormonal therapies

• steroids - glucocorticoid-induced osteoporosis

what are the risk factors for falls

• muscle weakness

• poor balance

• cognitive impairment

• polypharmacy

• vision impairment

• urinary incontinence

• environmental hazards

name 2 risk assessment tools for falls

FRAX and Q fracture

what is a fragility fracture

a fracture following a fall from standing height or less

name some falls prevention strategies

• weight bearing exercise

• smoking cessation

• alcohol moderation

• home safety interventions

• medication reviews

• vision correction