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Falls

Falls. อาจารย์สิรินทร ฉันศิริกาญจน คณะแพทยศาสตร์ โรงพยาบาลรามาธิบดี. 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

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Falls

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  1. Falls อาจารย์สิรินทร ฉันศิริกาญจน คณะแพทยศาสตร์ โรงพยาบาลรามาธิบดี 21/5/2003

  2. Fall in the elderly : Is it important ?

  3. Ac. confusion Falls Geriatric Giants Immobility Incontinence Pressure sore

  4. Usual causes of falls • Intrinsic factors • Extrinsic factors

  5. Intrinsic muscle weakness balance problem visual deficit cardiovascular abnormality functional impairment cognitive impairment Extrinsic Polypharmacy Environmental Risk Factors

  6. Predisposing and situational factors associated with risk of falling’

  7. Predisposing and situational factors associated with risk of falling’

  8. Predisposing and situational factors associated with risk of falling’

  9. Predisposing and situational factors associated with risk of falling’

  10. Predisposing and situational factors associated with risk of falling’

  11. Predisposing and situational factors associated with risk of falling’

  12. Predisposing and situational factors associated with risk of falling’

  13. Predisposing and situational factors associated with risk of falling’

  14. Predisposing and situational factors associated with risk of falling’

  15. Predisposing and situational factors associated with risk of falling’

  16. Predisposing and situational factors associated with risk of falling’

  17. Predisposing and situational factors associated with risk of falling’

  18. Intrinsic risk factor for falling • Age-related factors • chronic illness • acute illness • medication • physical deficits

  19. 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

  20. 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

  21. Chronic illnesses • neuromuscular disease • stroke • Parkinson’s disease • peripheral neuropathy • muscle weakness from disuse and deconditioning • dementia

  22. Chronic illnesses • bone and joint problems • arthritis • degenerative joint • diseases or deformities of the feet

  23. Chronic illnesses • specific disease processes • diabetes • heart disease and hypertension

  24. Acute illnesses • Infection • Myocardial infarction

  25. Medications • Polypharmacy • Long-acting hypnotics-anxiolytics • Tricyclic antidepressants • Antipsychotics • Other cardiac, diuretic, or antihypertensive drugs

  26. Drugs That May Affect Fall Risk

  27. Physical deficits • Orthostatic hypotension • Vision • Walking speed • Lower and upper extremity strength • Lower extremity sensory perception

  28. Extrinsic factors • environmental hazard • activity-related factor

  29. 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

  30. 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

  31. Extrinsic Risk Factors or Environmental Home Hazards • Lighting • Glare from unshielded windows or lamps or highly polished floors • Absence of night lights

  32. Extrinsic Risk Factors or Environmental Home Hazards • Bathroom • Low toilet seats and/or no secure grab bars • Absence of nonslip surfaces

  33. Extrinsic Risk Factors or Environmental Home Hazards • Other • Poorly maintained walking aids and equipment • Improper shoes (not slip-resistant, high-heeled, too large)

  34. 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

  35. A fall / falls…………….. Which fall (s) is / are significant ?

  36. A fall with • loss of conciousness • ? ? seizure

  37. Recurrent falls : > falls in 6 months period

  38. Focusing on history • : an environmental factors • : when • : how • : associated symptoms • : medications

  39. Basic Elements of a Falls History

  40. Basic Elements of a Falls History

  41. Basic Elements of a Falls History

  42. Basic Elements of a Falls History

  43. THANK you

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