Latest Headlines Call for Better Assessment of Older People’s Medication

Polypharmacy can compromise an elderly's safety
Polypharmacy can compromise an elderly’s safety

Older people are often prescribed multiple kinds of medicines (polypharmacy). Polypharmacy 3 may cause adverse side effects such as drug interactions and other complications. The problem affects all ages, but older people are more vulnerable because they have slower metabolism and can’t excrete chemicals as efficiently as younger people.

Although opioids are sometimes necessary to treat acute pain, they can cause sedation and dizziness, and can increase the risk of falling. Besides, prolong exposure to these drugs leads to addiction.

North America is currently experiencing opioid epidemic or crisis. This is due to rapid rise of using opioid drugs for pain management in the past 20 years. Recent investigation also found that opioid prescriptions in England has nearly doubled in 10 years.

Last week, two separate research studies again cautioned drug prescription to older people.

  1. Opioid use links to fall risk and increased likelihood of death in older adults

Data analysis on 67,929 patients aged 65+, who were admitted for injury, showed that those who were using opioid were 2.4 times more likely to have a fall injury. In addition, patients whose falls were linked to opioid use were also more likely to die during their hospital stay.

The study was published in the Canadian Medical Association Journal1 on April 23. 2018.

https://www.reuters.com/article/us-health-elderly-opioids-falls/for-elderly-opioids-tied-to-higher-risk-of-fall-related-injuries-and-deaths-idUSKBN1HV2MX

  1. Dementia is associated with some common medicines

A research study published in the British Medical Journal 2 on April 25, 2018, found that long-term use of anticholinergic* medicines links to dementia. These medications include those for treating depression, bladder control and Parkinson’s disease. Less potent anticholinergics, such as antihistamines and travel sickness drugs, appear harmless.

This is an extensive study carried out by researchers from the University of East Anglia, UK. The medical records of 40,770 patients with dementia were compared with those of 283,933 patients without the disease; and their prescriptions over two decades were analysed.

http://www.bbc.com/news/health-43881209

 

 

Notes:

*Anticholinergic drugs block the neurotransmitter acetylcholine in the central or peripheral nervous system. Anticholinergic drugs are used to treat many conditions: depression, gastrointestinal disorders, Parkinson’s disease, urinary incontinence, epilepsy, and allergies.

  1. Raoul Daoust, Jean Paquet, Lynne Moore, Marcel Émond, Sophie Gosselin, Gilles Lavigne, Manon Choinière, Aline Boulanger, Jean-Marc Mac-Thiong and Jean-Marc Chauny. Recent opioid use and fall-related injury among older patients with trauma. CMAJ April 23, 2018 190 (16) E500-E506. http://www.cmaj.ca/content/190/16/E500
  2. Kathryn Richardson, Chris Fox, Ian Maidment, Nicholas Steel, Yoon K Loke, Antony Arthur, Phyo K Myint, Carlota M Grossi, Katharina Mattishent, Kathleen Bennett, Noll L Campbell, Malaz Boustani, Louise Robinson, Carol Brayne, Fiona E Matthews, George M Savva, Anticholinergic drugs and risk of dementia: case-control study. BMJ 2018;361:k1315. https://www.bmj.com/content/361/bmj.k1315
  3. Duerden, M., Avery, T., & Payne, R. (2013). Polypharmacy and medicines optimization. Making it safe and sound. www.kingsfund.org.uk/sites/files/kf/field/field_publication_file/polypharmacy-and-medicines-optimisation-kingsfund-nov13.pdf

Unsafe Footwear Impairs Balance and Increases the Risk of Fall

Safe shoes fit securely and has non-slippery soles
Safe shoes fit securely and has non-slippery soles

Elderly who fell and injured themselves often were found wearing inappropriate shoes.

In “The Guideline for the Prevention of Falls in Older Persons”, both American Geriatric Society and British Geriatric Society have pointed out inappropriate footwear as a major cause of concern.

Whether indoor or outdoor, unsafe footwear can cause loss of balance and bad gait. The risk of falls is especially high for elderly whose muscular strength and balance are already impaired.

What kind of footwear increase the risk of falls?

Evidences collected by researchers show that falls were often associated with the following kinds of shoes:

  • Loose, worn or backless slippers. These are one of the most common causes of older people falling.

    Open-backed slippers and slip-on shoes are not safe for elderly
    Backless slippers and slip-on shoes are not safe for elderly
  • Poorly fitting shoes. To accommodate painful feet, some elderly like to wear soft and/or overly long and wide shoes.
  • Slip-on shoes, such as sling backs or flip flops and shoes without fasteners.
  • Shoes with poor grip or worn soles can cause you to slip especially on wet surfaces.
  • Shoes with minimal contact with the ground, such as high heels, can make your foot unstable and can cause your ankle to turn.

Wear Proper Shoes to Prevent Falls

People of all ages should understand the importance of wearing well-fitting shoes, and wear suitable shoes for a particular activity. One of the main causes of foot problems such as bunions and corns is badly-fitting shoes.

Apparently, three out of four people over the age of 65 wear shoes that are too small. Perhaps it is because we did not realise our feet actually get bigger as we age. Besides, the feet and ankles may become swollen because of chronic medical conditions.

It is often a combination of foot problems and inappropriate footwear that increases the risk of falling.

What are the characteristics of safe shoes?

  • It should fit well and neither too loose or too tight on the feet. Some people may need footwear specially made to accommodate and protect swollen feet and ankles.
  • It has a high back or collar to support the ankle.
  • The sole is firm and not too thick for better sensation of foot position.
  • The sole is slip resistant with tread for good grip.
  • A low square heel which is not more than an inch to improve stability.
  • Adjustable fastener – laces or buckles or Velcro – on the front so that it won’t slip off easily.

Indoor footwear

As mentioned earlier, elderly should avoid loose, backless slippers. It is recommended that older people wear close-backed, well-fitted, slip-resistant slippers or house shoes indoors. A house-shoe offers the comfort of a slipper, but with the stable support of a shoe.

A wide opening makes it easier to get your foot in and out of the slipper which is important if you have swollen feet. But make sure it can be strapped down securely so that it won’t slip off easily.

Do not walk bare-footed or in socks or stockings.

For some cultures and in hot climate, folks may prefer to walk bare-footed at home. However, it has been shown that a proper pair of shoes provide more grip than bare feet and enhance walking stability. Shoes also protect the feet from mechanical injuries.

Get help

Podiatrists, also called chiropodists in UK and Ireland, are foot care specialists. Ask your doctor to refer you to one if you have pain or any other foot problems.

Your podiatrist can help you choose suitable shoes and orthotic inserts if you need them.

Diabetes sufferers will benefit from seam-free footwear made to avoid rubbing, which can lead to ulcers that are difficult to heal. In UK, specially fitted footwear can be purchased free of VAT if the wearer has a chronic medical condition such as diabetes. You should be able to get further information about this from a podiatrist as well.

 

 

Further Reading:

Menant J, Steele J, Menz H, Munro B, Lord S (2008). Optimizing Footwear for Older People at Risk of Falls. Journal of Rehabilitation Research & Development, 45(8), pp. 1167–1182.

 

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