Study,Jan/19:Falls in institutionalized elderly with & without cognitive decline

The full title of this Portuguese study is "Falls in institutionalized elderly with and without cognitive decline A study of some factors."

 

https://www.ncbi.nlm.nih.gov/pubmed/31073388 

 

Abstract in English, Portuguese

 

Falls in long-stay institutions for elderly people have a high prevalence, contributing to the physical and mental deterioration of institutionalized elderly.

 

Objective:

 

To determine the prevalence of falls among institutionalized elderly with and without cognitive decline, and to characterize the practices and behaviors of those with and without cognitive decline in managing fall risks, and relate them to some factors.

 

Methods:

 

The present correlational study was carried out with a sample of 204 institutionalized elderly, 50% of whom had cognitive decline.

 

Results:

 

The elderly with cognitive decline (40.2%) fell less often than those who did not have cognitive decline (42.2%) (p>0.05). Safety practices and behaviors were better in the elderly with cognitive decline (p<0.05). Most of the elderly with cognitive decline who fell took benzodiazepines (65.9%), in contrast with those without cognitive decline (32.2%). It was observed that 81.4% of the elderly without cognitive decline and 43.9% of those with cognitive decline who fell had a performance of over 12 seconds on the Timed Up and Go Test, where differences reached statistical significance in both groups of elderly.

 

Conclusion:

 

Data collected in the present study further the knowledge on risk factors in the genesis of falls and on the behavior of elderly with and without cognitive decline in maintaining their safety in self-care and accessibility.

I think the UK figures would be worse

They use seroquel AKA the chemical cosh here.

Little old lady cant sleep, added seroquel, fractured hip, 18 hours on a stretcher, does not survive surgery.

Coroners case, but waived though

It makes my blood boil.

Thanks for the link Lapis2

 

eg  https://www.rpharms.com/.../The%20Right%20Medicine%20-%20Care%20Home%20.

Yes, agreed, Forty. Benzos, anti-psychotics, SSRIs, etc....They can all make people dizzy and then fall. If a fall results in a fractured hip, the person likely becomes bedridden and may get pneumonia. Cause of death would not show the medication; It would show pneumonia. So the numbers don't reflect reality.

 

I've come across SO MANY studies on falls and fractures from meds in long-term care facilities that I end up shouting at the computer. Okay! Enough studies! Let's DO SOMETHING about it already!

Can’t voice more publicly so will pm you

D

 

Yes, agreed, Forty. Benzos, anti-psychotics, SSRIs, etc....They can all make people dizzy and then fall. If a fall results in a fractured hip, the person likely becomes bedridden and may get pneumonia. Cause of death would not show the medication; It would show pneumonia. So the numbers don't reflect reality.

 

I've come across SO MANY studies on falls and fractures from meds in long-term care facilities that I end up shouting at the computer. Okay! Enough studies! Let's DO SOMETHING about it already!

What “something” do you recommend given that the subjects in these studies are probably members of the “taken as prescribed” community?

I'm talking about prevention. Don't start people on the meds in the first place and/or, if they're already on the meds, monitor these people properly. And taper where possible. All of these meds are known to have deleterious effects on the vestibular system -- and it's worse for elderly people who metabolize things more slowly. A little goes a long way.

So sad, so much ignorance

I'm talking about prevention. Don't start people on the meds in the first place and/or, fi they're already on the meds, monitor these people properly. And taper where possible. All of these meds are known to have deleterious effects on the vestibular system -- and it's worse for elderly people who metabolize things more slowly. A little goes a long way.

Agree re: prevention if you mean physicians should be extremely careful and cautious re: prescribing benzodiazepines to “benzo-naive” patients (i.e. those who have never used benzos before or only on a one-time basis).  But what about “taken as prescribed” patients especially the “elderly”?  What’s your confidence level that physicians know what they need to know and do to help their elderly patients taper without harm?

Yes, agreed, re: don't add new prescriptions. As far as knowledge about tapering, there's information out there and there's research ongoing (e.g. Canada's Deprescribing.org). Obviously, doctors need to access the information and use it appropriately. Producing study after study that confirms what's already known about the dangers of benzos and anti-psychotics with regards to balance doesn't make sense to me. Use the knowledge that's out there and save some lives.

I can only speak for myself, but I am 65+ and the tapering guideline my doc used was a complete disaster. 

I'm really sorry to hear about that, Libertas. I just don't think doctors can claim ignorance when there IS information available. My doctor didn't know about benzo tapering, but I brought the Ashton Manual to his office, and he agreed to support the path I'd chosen based on the Manual's instructions. I was in control.

 

Here are some links to the organization I was talking about. Their focus is safe deprescribing for the elderly population -- not just benzos, but other meds that may be causing problems for people.

 

https://deprescribing.org/

 

https://deprescribing.org/about/

I aggree lapis, -for any Dr that WANTS to know, There is enough info available to atleast let us have significant imput int our own cessation protocols, -and for them to assist with appropriate advices or cautions..

 

I only have one leg that works, apart from the Gabapentin/lyrica, I did fine, -maybe a few oopses..

But after this recent C/O I just did, which realy rattled me some. i have been all over the place, and just this morning took out the fridge like a star quaterback.. Trouble is, If its continuous one tends to cater for it, but random events can realy catch us out...

 

For those that dont suffer this, It can be hard to understand.. All the transfer precautions in hospital drove me nuts, I was so non compliant, never an issue..  But I have noticed recently that I like to take one crutch for balance if im going out...

 

Atleast if we are aware, we can self evaluate and then cater, if needed... It should be our prescribers job to ensure that we are aware or informed, and I guess they need to be taught this too.. Not that its a stretch to connect the dots, Imo..

 

I'm really sorry to hear about that, Libertas. I just don't think doctors can claim ignorance when there IS information available. My doctor didn't know about benzo tapering, but I brought the Ashton Manual to his office, and he agreed to support the path I'd chosen based on the Manual's instructions. I was in control.

 

Here are some links to the organization I was talking about. Their focus is safe deprescribing for the elderly population -- not just benzos, but other meds that may be causing problems for people.

 

https://deprescribing.org/

 

https://deprescribing.org/about/

That’s wonderful that your doc was open to learning about Ashton and willing to support you.

 

Thank you for bringing the work of the Bruyère Deprescribing Guidelines Research Team to our attention.  The team has developed a methodology to generate “evidence-based” guidelines for desprescribing in older adults.  However, like all such methodologies, the quality of the guidelines generated depend on the quality of the evidence available. The authors of the guidelines for benzos rate the quality of evidence as “weak.”

 

As always I encourage members of this community to read the original source document so they can form their own opinions.  Here’s the title and a link to the pdf:

 

Deprescribing benzodiazepine receptor agonists: Evidence-based clinical practice guideline

https://www.cfp.ca/content/cfp/64/5/339.full.pdf

 

Below are some snippets from the original source doc and desprescribing algorithm:

These recommendations apply to patients who use BZRAs to treat insomnia on its own (primary insomnia) or comorbid insomnia where potential underlying comorbidities are effectively managed.

 

This guideline does not apply to those with other sleep disorders or untreated anxiety, depression, or other physical or mental health conditions that might be causing or aggravating insomnia.

 

Taper slowly and in collaboration with the patients, for example 25% reduction every 2 weeks and a slower taper of 12.5% every 2 weeks near the end of stopping, followed by periodic drug-free days

 

If dosage forms do not allow 25% reductions, consider 50% reductions using drug-free days during later part of tapering

 

Withdrawal symptoms ... are usually mild and last for days to a few weeks

 

And I can't really weigh in on much on those with "primary insomnia" only, as per these guidelines. What I do know is that they're doing ongoing research and, hopefully, not doing a cookie-cutter approach to tapering. At least, that's what it seems they're doing from what I've read and seen.

 

Personally, I wasn't in the "primary insomnia" category when I started down this road. I'm not sure about other BBs, but I think for lots of us here, it was a bit more complicated.

 

In the meantime, I'm interested to see the developments with Deprescribing.org. I heard one of the lead doctors on CBC Radio some time ago and liked what I heard from her. She's done quite a bit of research in this area already.