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Falls in the Elderly

dr Putra Hendra SpPD


UNIBA
Masalah utama GERIATRICS
(Isaacs 1970)

 Immobility
 Instability
 Intellectual Impairment
 Incontinence
 Iatrogenesis
Definition

 Jatuh terjadi bila terjadi ketidak seimbangan


antara beban dengan kemampuan menjaga
stabilitas postural.
Incidence rates of Falls in U.S.

Per person annually

Community 0.2 - 0.8


Hospital 0.6 - 2.9
Long term- 0.2 - 3.6
Care (per bed)
One of every three adults
over 65 years fall in every year
How serious is the
problem of falls?
Where are people likely to fall?
For people 65 years old or older…..

Nursing Home 10%

Home 60%
Public Places 30%
Consequences of Falls
 Mortality
 Morbidity
 Fractures
 Soft tissue injuries
 Head trauma
 Joint distortions and dislocations
 Loss of confidence - fear of falling
 Restricted activity
 In 1994, estimated fall-related injury
cost was $20.2 billion.
Fractures

 3% of all falls menyebabkan fractures.


 95% of hip fractures pada manula
adalah akibat jatuh.
 Seseorang dengan hip facture sekitar
5 ~20% biasanya meninggal pada
tahun pertama
Common Types of Fractures
 Forearm (Wrist) Fracture
 Spine Fracture
 Hip Fracture (pelvis, hip, femur)
 Ankle Fracture
 Upper arm, forearms, hand
Perawatan di rumah sakit akibat hip
fractures, aged  65 years, 1996

Men ( n=68,783) Women(n=270,909)


Rates Rates
Age (years)
65-74 168.0 501.1
75-84 682.1 1,620.3
 85 2,256.2 3,958.3

Per 100,000 population


Source: National Center for Health Statistics, CDC
Akibat takut jatuh

 Tidak percaya diri


 physical activity ↓
 quality of life ↓
Risk faktor jatuh (intrinsik)
 Aged (over 65 years)
 Female
 Low mobility or fragility – lower extremity
weakness, Kemampuan memegang↓
 Gangguan fungsi (melihat, mendengar) ↓
limited Activities of Daily living (ADL)
 Gangguan keseimbangan
 Low body weight
 Cognitive ↓, dementia
 Chronic illness
- Parkinson disease, visual difficulties,
stroke, hypertension, or urinary
incontinence
 Psychoactive medication
- tranquilizers or antidepressants
 Jatuh sebelumnya
 Peminum berat
Relative risk ratio (RR) or Odd Ratio (OR) of Fall
5,0 4,4
4,5
Mean RR or OR

4,0
3,5 2,9 2,9 3,0
3,0 2,5 2,6
2,5
2,3 2,2 2,4
2,0 1,7 1,8
1,5
1,0
0,5
0,0

r s ss cit cit L nt
on ti s cit lls ce
e a e fi fi AD e si r i fi fa vi
y kn de de d irm es rth de of de
80 ea ait ce aire pa epr A ual ry ive
> e w G an p im D i s sto ist
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Ag usc Ba I itiv H ass
M gn s e
Co U
J Am Geriatr Soc. 2001
Penyebab Extrinsic atau faktor
lingkungan
 Polypharmacy – four or more
prescription medications combination
 Lingkungan rumah
 Clutter,or loose rugs
 Poor lighting on stairs and hallways
 Lack of bathroom safety, e.g. palang
pegangan di kamar mandi
 Footwear (sepatu)

 Lalu lintas ramai


Mechanisms of Fall
Contributing
Intrinsic : factors Extrinsic :
Aging, poor balance Home hazards

Occurrence of falls

No injuries
Fall Outcomes

Soft tissues Loss of Disability,


Fractures
injures, Confidence reduced
trauma quality of life
Dimension of Fractures

Force

Bone Fragility Fall itself

Source: National Osteoporosis Foundation


Jatuh sendiri

 Loss of footing or loss of traction


 Changes of reflex with age
 Changes of muscle mass and body fat
 Loss of muscle strength
 Changes in vision and hearing
 Chronic conditions with medications
Fragile Bone
 Osteoporosis, or brittle bones
 Fall induced fractures
Osteoporotic Bone
Normal Bone

Dempster et al., JBMR 1986


Prevention/Intervention
Assessment of Risk
 “Get-up and Go” Test (Mathias et al., 1986)
 Check for balance, gait, and mobility
 Review
 Chronic medical conditions
 Medications
 Visions and hearing ability
 Foot disabilities
 Evaluate environmental hazards
 Home hazards
J Am Geriatr Soc. 2001
Personal Prevention

 Home Safety – Reducing hazards


Check for Safety List (CDC)
 Balance Exercise Lessen Fall impact –
hip protectors
 Healthy Life Style
Assistant Devices
 Hip pads
 Mobility aids
 Cane
 Walkers
 Wheelchairs
 Bathroom aids
- Raised toilet seats
- Grab bars
Intervention Programs
 Exercise or physical therapy 
 muscle strength ↑

 Balance
 gait
 Menilai keamanan rumah
 Evaluasi kondisi medis, obat dan nutrisi
 Support groups
Community Intervention
Reduction of fall
 Intensive strength
 endurance training
 balance training
 e.g. “Tai Chi C’uan” reduced the rate of
falls during the 4 months follow up in
women at moderate risk of falls.

Province et al., 1995 JAMA


Modifiable Risk Factors for Falls in
the Community
Psychotropic drugs – especially benzodiazepines
Multiple drugs
Postural Hypotension
Environmental hazards
Vision
Poor balance or gait
Poor functioning with ADLs
Footwear
Avoiding Injury - Treating Osteoporosis
Vitamin D Deficiency and Falls

 Causes muscle weakness and probably falls


 Leads to osteoporosis and increased risk of
fracture
 Very common in elderly