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FALLS AND GAIT DISORDERS IN ELDERLY

FALLS AND GAIT DISORDERS IN ELDERLY. Presented by Dr Marie Makhoul Moderator Dr Nabil Naja Wednesday, March 5,2003. OBJECTIVES. You should know It is a common and serious problem How to evaluate an old patient after a fall The principles of management of fallers. EPIDEMIOLOGY.

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FALLS AND GAIT DISORDERS IN ELDERLY

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  1. FALLS AND GAIT DISORDERS IN ELDERLY Presented by Dr Marie Makhoul Moderator Dr Nabil Naja Wednesday, March 5,2003

  2. OBJECTIVES You should know • It is a common and serious problem • How to evaluate an old patient after a fall • The principles of management of fallers Dar Al-Ajaza Al-Islamia Hospital in Beirut

  3. EPIDEMIOLOGY • The number of falls increases with age. The annual incidence is 30% over 65 years of age;and 50% over 80. • Falls are among the major causes of morbidity: 5-15%→Major trauma 6%→ Fractures 1-2%→Hip fractures(osteoporosis) Dar Al-Ajaza Al-Islamia Hospital in Beirut

  4. EPIDEMIOLOGY • Hospital stays are almost twice • They experienced a greater functional decline in ADL,physical and social activities • Trauma is the fifth leading cause of death in elderly and Falls account for 2/3 of these • “Syndrome post-chute” Dar Al-Ajaza Al-Islamia Hospital in Beirut

  5. NORMAL AGE-RELATED CHANGES • GAIT: Decline in Velocity(speed) about 15% per decade because of shorter steps. Cadence (rhythm) does not change with age Double stance(support)increase with age from 18% to 26% . Dar Al-Ajaza Al-Islamia Hospital in Beirut

  6. NORMAL AGE-RELATED CHANGES • POSTURE: Decreased proprioception Slower righting reflexes Decreased muscle tone Hypopallesthesia Flexed posture with wide based • VISUAL ABILITIES Dar Al-Ajaza Al-Islamia Hospital in Beirut

  7. RISK FACTORS : • Older age (>75 years) • Housebound status • Living alone • Use of cane or walkers • Previous falls • Acute illness • Chronic conditions • Medications Dar Al-Ajaza Al-Islamia Hospital in Beirut

  8. RISK FACTORS : • Cognitive impairment • Reduced vision • Foot problems • Neurological changes • Decreased hearing • Environmental hazards Dar Al-Ajaza Al-Islamia Hospital in Beirut

  9. COMMON CAUSES • Accident, environmental hazards • Gait disturbance,balance disorders,pain • Vertigo • Medications or alcohol • Acute illness • Confusion or cognitive impairment • Postural hypotension • Visual disorder • Central nervous disorder Dar Al-Ajaza Al-Islamia Hospital in Beirut

  10. ENVIRONNEMENTAL HAZARDS • Old, unstable,and low-lying furniture • Beds and toilets of inappropriate height • Unavailability of grab bars • Uneven stairs and inadequate railing • Throw rugs ,frayed carpets,cords,wires • Slippery floors and bathtubs • Inadequate lighting or glaring • Cracked and uneven side walks Dar Al-Ajaza Al-Islamia Hospital in Beirut

  11. EVALUATIONSCREENING • If known risk factors→question about falls • If first fall +injuries,new acute illness,loss of consciousness,fever or abnormal blood pressure→immediate evaluation • If recurrent falls (>2/6 months)→ evaluation for treatable causes Dar Al-Ajaza Al-Islamia Hospital in Beirut

  12. EVALUATIONHISTORY Determine possible causes of falling specific risk factors impairment that contribute to it Dar Al-Ajaza Al-Islamia Hospital in Beirut

  13. HISTORY Ask about -the circumstances of the fall - the seriousness of the fall -witnesses -injuries -previous falls Dar Al-Ajaza Al-Islamia Hospital in Beirut

  14. EVALUATION PHYSICAL EXAM • Focus on common problems: vital signs, cardiovascular, neurological, musculosqueletic exam, foot exam. • Recognize the complications of trauma: hematoma, fractures… Dar Al-Ajaza Al-Islamia Hospital in Beirut

  15. PHYSICAL EXAM • Gait and balance testing: gait testing “Up & Go “test “Get-up and go”test One leg balance Retropulsion test Tinetti test ADL ;IADL • Home visit for assessment if possible Dar Al-Ajaza Al-Islamia Hospital in Beirut

  16. MANAGEMENT PREVENTION • Eliminate environmental hazards, foot problems • Improve home support, family • Provide opportunities for socialization • Modify medications,prevent postural hypotension • Modification of lifestyle: nutrition,.. • Provide balance training, gait training • Treat pain • Provide follow-up Dar Al-Ajaza Al-Islamia Hospital in Beirut

  17. MANAGEMENTTHERAPY • Assess and treat complications • Treat underlying conditions • Provide physical therapy and education: Gait retraining Muscle strengthening Use of assistive devices Adaptive behaviors Dar Al-Ajaza Al-Islamia Hospital in Beirut

  18. THERAPY • If recurrent falls: use of protectors(hips,…) • Alter the environment • Prevent “Syndrome post-chute” , recurrence Dar Al-Ajaza Al-Islamia Hospital in Beirut

  19. CONCLUSION • Falls is a common problems with high morbidity • One fall has multiple causes • We should do screening in every old patient with known risk factors Dar Al-Ajaza Al-Islamia Hospital in Beirut

  20. CONCLUSIONS • We should do a complete evaluation for falls in certain circumstances • Prevention and management should be done at multiple levels Dar Al-Ajaza Al-Islamia Hospital in Beirut

  21. THANK YOU FORYOUR ATTENTION END

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