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Dr. Rose Dinda Martini, SpPD

Dr. Rose Dinda Martini, SpPD. Instabilitas dan Jatuh. Epidemiology. 30-40% over the age of 65 years fall each year 50% for those > 80 years Almost 60% of those with a history of a fall in the previous year will have a subsequent fall. 5-10% of falls result in major injuries:

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Dr. Rose Dinda Martini, SpPD

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  1. Dr. Rose Dinda Martini, SpPD Instabilitas dan Jatuh

  2. Epidemiology 30-40% over the age of 65 years fall each year 50% for those > 80 years Almost 60% of those with a history of a fall in the previous year will have a subsequent fall. 5-10% of falls result in major injuries: fracture, head trauma, or major lacerations Fauci, et al. Harrison’s Principles of Internal Medicine 17th ed 2008

  3. The multi-factorial and interacting causes of falls • Intrinsic risk factors • Gait and balance impairment • Peripheral neuropathy • Vestibular dysfunction • Muscle weakness • Vision impairment • Medical illness • Advanced age • Impaired ADL • Orthostatic • Dementia • drugs • Precipitating causes • Tips & slips • Drop attack • Syncope • Dizziness • Acute medical illness FALL • Extrinsic risk factors • Environmental hazard • Poor footwear • Restraints Rubenstein, LZ, Josephson, KR. Falls and their prevention in elderly people: What does the evidence show? Med Clin North America 2006; 90:807.

  4. What determines the risk of fracture among those who fall??? Acase-control study in 205 patients with hip fracture and 207 control subjects showed a strong relationship betweennumber of falls, as well asfalling while turningand hip fracture risk (Cumming et al. JAGS 1994;42:774-8) Another study compared 32 patients who sustained a hip fracture after a fall with 100 control patients who fell without developing hip fracture, found:falls to the side, low hip bone density, impairedmobilityas risk factors of hip fracture (Greenspan et al. Am J Med 1998; 104: 539-45)

  5. Impaired mobility, disability Impaired gait and balance Neuromuscular or musculoskeletal disorders Age Neurological heart disorders History of falls Medication Cognitive impairment Risk Factors Associated Falls Pathy. Principle & Practice of Geriatric Medicine 2006;1288

  6. PENDAHULUAN Jatuh  kualitas hidup , karena jejas jaringan, nyeri, imobilisasi, fraktur Mekanisme jatuh pada usila : Terpeleset (slip) Tersandung (trip) Jatuh : ketidakmampuan untuk mempertahankan pusat gravitasi diantara kedua kaki Control (neurologis), actuating (muskular), framework (skeletal) Integritas : visual, vestibular, propioseptif, tactile, visiospatial, adaptability of muscle tone, kekuatan otot, fleksibilitas

  7. Strategi Postural A. Strategi pergelangan kaki B. Strategi panggul C. Strategi suspensori D. Strategi melangkah/mennggapai

  8. Faktor risiko intrinsik Faktor risiko ekstrinsik INSTABILITAS  JATUH

  9. JATUH Terpeleset (slip) : berhubungan dengan gangguan ketajaman penglihatan dan koordinasi biasanya pasien akan terayun ke belakang Tersandung (trip): kelemahan otot pangkal paha berhubungan dgn gangguan proprioseptif dan gangguan visuospasial

  10. FAKTOR INTRINSIK Vertigo dengan berbagai penyebab Sinkop, sway, drop attacks, dizziness Gangguan penglihatan Gangguan pendengaran Penyakit sistemik, terut. KV dan neurologis Penyakit Parkinson, hidrosefalus tekanan normal, tu intrakranial, SDH, gangg serebelum Gangguan muskuloskeletal  OA genu, plantar fasciitis Gangguan proprioseptif

  11. LAIN-LAIN : Dehidrasi TIA, stroke akut Parkinsonism, Penyakit Parkinson, hidrosefalus tekanan normal  gangg gaya berjalan Gangg serebelum, tumor intrakranial, SDH  ketidakstabilan  cenderung mudah jatuh Deconditioning effect  keadaan reseptor saraf propioseptif yang terkondisi pasien pada keadaan berbaring  saat duduk atau berdiri, sensasi perubahan lambat  pusing, kepala berat, mau jatuh

  12. FAKTOR EKSTRINSIK Faktor-faktor yang berada di lingkungan yang memudahkan usila mengalami jatuh Sebagian besar jatuh terjadi pada aktifitas ringan, dan di dalam rumah Faktor-faktor : Lampu kurang terang, lantai licin atau bertingkat, tangga, kloset dan bak mandi, karpet, kain panjang, tali sepatu, mainan anak-anak Pengaruh obat-obatan (dizziness, vertigo, hipotensi, hiponatremia): diuretik, antihipertensi sentral, sedatif

  13. Jatuh di rumah Slipping di tangga : Biasanya pada saat turun tangga : keliru mengira sudah sampai tingkat terbawa Tinggi pegangan sebaiknya 92 cm (biasanya 82 cm) Pegangan Ø 44 mm (power grip) atau 112- 132 mm

  14. PEMERIKSAAN Tidak ada gold standard Brp alat ukur dikembangkan untuk mendeteksi adanya instabilitas Uji fungsional : The timed up-and-go test (TUG) Uji menggapai fungsional (Fungsional reach test) Uji keseimbangan Berg

  15. From CK Cassel et al. Geriatric Medicine: An Evidence-Based Approach, 4th ed. New York, Springer-Verlag, 2003

  16. Komplikasi Akibat/komplikasi terpeleset (slip) : Cidera jaringan lunak sekitar bokong dan panggul Colle’s fracture Fx. corpus vertebra Lumbosakral), fx. pangkal femur Cidera belakang kepala  kontusio, atau laserasi Imobilisasi

  17. Komplikasi Akibat tersandung (trip) : Cedera bagian frontal kepala Colle’s fracture Cidera lutut Fraktur pangkal paha Imobilisasi

  18. Impact of Hip Fractures 1% of falls result in hip fracture $2 billion + in medical costs annually 25% die within 6 months 60% have restricted mobility 25% remain functionally more dependent

  19. PENYULIT JATUH Memar/kontusio jaringan lunak, dan perdarahan, nyeri, gangguan mobilitas, ketergantungan Colle’s fracture : Ahli bedah ortopedi Gipsum untuk imobilisasi sendi pergelangan tangan Aktivitas dibantu Fraktur vertebrae, femur proksimal : Hambatan aktivitas yg hebat, imobilisasi Nyeri hebat saat transfer Menyulitkan proses transfer

  20. Algorithm Summarizing the Clinical Approach to the Prevention of Falls among Elderly Persons Living the Community N ENGL J MED 348;1,2003

  21. Figure Assassment and Management of Falls

  22. PENCEGAHAN Pengkajian geriatri paripurna Menemukenali semua faktor resiko Target intervensi faktor resiko (intrinsik dan ekstrinsik) Latihan keseimbangan, penguatan otot pangkal paha, gaya/ayunan jalan Alat bantu Edukasi

  23. Kesimpulan • Proaktif anamnesis keluhan instabilitas jatuh • Gangguan keseimbangan, jatuh, fraktur : masalah besar (geriatric giant) usila • Jatuh – problem instabilitas • Identifikasi faktor intrinsik (>) & ekstrinsik • Perlu pemeriksaan sensorik, motorik, koordinasi • Prevensi terjadi jatuh lebih penting & utama daripada kurativ

  24. Hartford: Capital Steps Scare

  25. TerimaKasih

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