Falls อาจารย์สิรินทร ฉันศิริกาญจน คณะแพทยศาสตร์ โรงพยาบาลรามาธิบดี 21/5/2003
Fall in the elderly : Is it important ?
Ac. confusion Falls Geriatric Giants Immobility Incontinence Pressure sore
Usual causes of falls • Intrinsic factors • Extrinsic factors
Intrinsic muscle weakness balance problem visual deficit cardiovascular abnormality functional impairment cognitive impairment Extrinsic Polypharmacy Environmental Risk Factors
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Predisposing and situational factors associated with risk of falling’
Intrinsic risk factor for falling • Age-related factors • chronic illness • acute illness • medication • physical deficits
Age-related factors contributing to instability and falls • Changes in postural control • decreased proprioception • slower righting reflexes • decreased muscle tone • increased postural sway • orthostatic hypotension
Age-related factors contributing to instability and falls • Changes in gait • feet not picked up as high • men : develop flexed posture and wide-based, short-stepped gait • women : develop narrow-based, waddling gait
Chronic illnesses • neuromuscular disease • stroke • Parkinson’s disease • peripheral neuropathy • muscle weakness from disuse and deconditioning • dementia
Chronic illnesses • bone and joint problems • arthritis • degenerative joint • diseases or deformities of the feet
Chronic illnesses • specific disease processes • diabetes • heart disease and hypertension
Acute illnesses • Infection • Myocardial infarction
Medications • Polypharmacy • Long-acting hypnotics-anxiolytics • Tricyclic antidepressants • Antipsychotics • Other cardiac, diuretic, or antihypertensive drugs
Drugs That May Affect Fall Risk
Physical deficits • Orthostatic hypotension • Vision • Walking speed • Lower and upper extremity strength • Lower extremity sensory perception
Extrinsic factors • environmental hazard • activity-related factor
Extrinsic Risk Factors or Environmental Home Hazards • Ground surfaces • Throw rugs or loose carpets • Slippery floors • Low-lying objects on the floor e.g,. cords and wires • Stairs with rugs or in poor repair
Extrinsic Risk Factors or Environmental Home Hazards • Furniture • Unstable or low-lying furniture • Low chairs without armrest support or seat back • Beds/cabinets that are too high or too low
Extrinsic Risk Factors or Environmental Home Hazards • Lighting • Glare from unshielded windows or lamps or highly polished floors • Absence of night lights
Extrinsic Risk Factors or Environmental Home Hazards • Bathroom • Low toilet seats and/or no secure grab bars • Absence of nonslip surfaces
Extrinsic Risk Factors or Environmental Home Hazards • Other • Poorly maintained walking aids and equipment • Improper shoes (not slip-resistant, high-heeled, too large)
EXTRINSIC FACTORS INTRINSIC FACTORS Medications Medical and neuropsychiatric conditions Improper prescription and/or use of assistive devices for ambulation FALLS Impaired vision and hearing Environmental hazards Age-related changes in neuromusclar function, gait and postural reflexes
A fall / falls…………….. Which fall (s) is / are significant ?
A fall with • loss of conciousness • ? ? seizure
Recurrent falls : > falls in 6 months period
Focusing on history • : an environmental factors • : when • : how • : associated symptoms • : medications
Basic Elements of a Falls History
Basic Elements of a Falls History
Basic Elements of a Falls History
Basic Elements of a Falls History
THANK you
