RESIKO JATUH

Novaria Puspita,dr.

Pembimbing :
DR.Med. Sc. Irma Ruslina Defi, Sp.KFR(K)
• Jatuh merupakan salah satu penyebab morbiditas terbanyak pada
populasi lanjut usia (lansia)
• Trauma fisik dan kecelakaan merupakan penyebab utama kematian
terbesar kelima pada kelompok usia 65 tahun ke atas  dua pertiga
dari jumlah kematian tersebut berhubungan dengan insiden jatuh serta
komplikasinya
• Kejadian jatuh pada lansia dapat menimbulkan cedera, disabilitas
bahkan kematian
Definisi Jatuh
• World Health Organization : sebuah kejadian yang menyebabkan
seseorang terbaring di tanah, lantai atau tingkat yang lebih rendah
secara tidak disengaja
Areas where falls occur at home
9% 7%
4%
WC Laundry Kitchen Meals

Pantry
Living Dining

50% Bathroom

Living Entry Bedroom

Source:
Garage
Victorian Injury Surveillance System 5%
25%
 ABC’s of Why Older Adults Fall
Usually >1 Risk Factor Causes a Fall
1. Age, ambulatory status, assistive device use
2. Balance, behavior at time of fall
3. Chronic conditions, cognitive deficits
4. Drugs
5. Exercise level, environment
6. Footwear & flooring
• Seorang lansia yang pernah jatuh mempunyai risiko untuk jatuh
kembali sebesar tiga kali lipat, biasanya dengan faktor penyebab yang
sama
• Jatuh dapat merupakan indikator awal adanya problem akut (infeksi,
hipotensi postural, aritmia jantung), progresivitas dari penyakit kronik
(neuropati diabetikum dan demensia)
• merupakan tanda proses penuaan yang terjadi pada sistem penglihatan,
berjalan atau kekuatan otot
 Primary Fall Risk Factor Concepts
• Assess & identify intrinsic (internal) risk factors
Examples- Age, osteporosis, vision loss, dementia

• Assess & identify extrinsic (external) risk factors:

Examples- Medications, footwear, assistive devices,
environment

• Assess & identify acquired risk factors:

Examples- Facility or hospital admission due to health
change or decline (new environment), delirium due
to illness, increased disability due to injury
 Secondary Fall Risk Concepts
• Identify modifiable risk factors
Examples: Muscle weakness, poor balance, exercise
level, medications, environmental lighting, footwear

• Identify non-modifiable risk factors

Examples: Age, chronic conditions, disability,
dementia, vision loss

Goal Individual will modify (reduce)

modifiable risk factors
 Fear of Falling
• Having a fear of falling has been identified as an intrinsic risk factor for actually falling
• It is defined as a lasting concern about falling that can lead to an individual's avoiding activities that he
or she remains capable of performing
• fear of falling causes a decrease in activity, which leads to reduced mobility and the loss of physical
activity, and increases the individual's actual risk of falling
• elderly adults who develop a fear of falling limit their travel outside of their homes and their enjoyment
of life experiences
 Fear of Falling

• fear of falling has been identified in the literature for many

years and has been referred to by various names, such
as postfall syndrome and self-efficacy
many different scales have been developed and utilized in
an attempt to quantify an individual's fear of falling :
• common scales include the Falling Efficacy Scale (FES)
(Tinneti)
• Activities-Specific Balance Confidence Scale
• the Geriatric Fear of Falling Measurement
 Reducing the Fear of Falling
• Screening for the fear of falling is one of the first steps to
reduce older adults' fear
• Implementing evidenced-based strategies for decreasing
the fear of falling is the second step
• Numerous evidence-based interventions aimed at
reducing the fear of falling have been studied : exercise-
based programs, education, home modification
CDC Fall Prevention Recommendations: the 4 Pearls

• Regular exercise
• Medication review
• Vision exams
• Home safety evaluation
 Fall Prevention Best Practices:
Multi-component Programs
Combine > 2 Best Practices
1. Individual risk assessment
2. Regular strength & balance exercise
3. Gait & assistive device training
4. Medication review & management
5. Management of chronic conditions
6. Vision correction
7. Education
8. Home safety improvements
WA State Dept. of Health, Falls Among Older Adults: Strategies for Prevention (2002)
Centers for Disease Control
 Best Practices for Older Adults from Recent Clinical
Studies
1. Clinical assessment & risk reduction
2. Exercise to improve balance, gait, strength, endurance, &
flexibility
3. Medication management: especially benzodiazepines,
antidepressants, sedatives/hypnotics
Rubenstein et al, Handbook of Injury & Violence Prevention, 2007
Recommendations for Community-dwelling Older
Adults (excl. those with dementia):
Cochrane Review of 111 Studies (2009)

1. Exercise:
-multiple component (strength, balance,
aerobic) group classes
-Tai Chi
-home programs in adults without severe
impairments
2. Multifactorial interventions, delivered by
multidisciplinary teams
Gillespie et al, Cochrane Review: Interventions for preventing falls in older
people living in the community, April 2009
 Strategies for preventing falls
due to impaired vision
 Annual check ups with optometrist
 Specialist referral for eye problems
 Ensure the environment is safe
 Occupational therapy home assessment
 Vision Australia referral
 Colour contrasting
 Adequate lighting
 Glare reduction
Color contrasting
Color contrasting
 Falls management &
medications
 Regular review of medications
 Keep a medication list
 Use of Webster packs or dosettes
 Use the same doctor if possible
 Assistance with medications e.g. District Nurse
 Obtain information on side effects
 Inform doctor of any side effects suffered
 Inform doctor about herbal medications being taken
 Discuss any medication changes with your doctor
 Postural hypotension
A drop in blood pressure after standing up
Causes:
 Dehydration
 Cardiac disease
 Drug side affects
 Prolonged bed rest
 Dysfunction in the nervous system
 Certain chronic & acute illness
 How to get up safely

 Sit on the edge of the bed or chair with feet on

the floor for a few minutes before getting up
 Stand up slowly using both arms to push up for
support
 Make sure you have good balance and do not
move off if you feel lightheaded or dizzy
 Use support when bending down and stand
back up slowly
 Reducing falls from
postural hypotension

 Regular medication reviews

 Inform doctor of any side affects from
medications (prescribed or other)
 Ensure adequate fluid intake
 Treatment and control of associated
diseases
Lack of physical exercise

Reduced activity leads to:

 Reduced muscle tone and bone density

 Loss of strength

 Poor balance and coordination

 Reduce mobility

 Increased frailty

 Reduced quality of life

Staying active
exercise & training
 Strength and Balance training
 Hydrotherapy/water exercise
 Exercise programs
 Tai Chi
 Walking for 30 minutes most days of the week
 Dancing
 Ask you doctor or physiotherapist for an
exercise program that is suitable for you
 Reducing falls from
foot disorders

 Purchase of properly fitting shoes

 Referral to podiatrist for treatment of foot
disorders
 Referral to podiatrist for advice on
purchasing of shoes
 Referral to a specialist for treatment of foot
disorders
 Reducing falls from unsafe
shoes
Purchase safe footwear:
 Flat sole

 Broad rounded heel

 Flexible sole

 Good grip

 Lace ups if possible or velcro fasteners

 Shoes that are enclosed at the front and back

 Avoid scuffs, thongs, high heels, and sling backs

 Don’t wear socks without shoes

 Summary
• Risk factors, best practices & effective interventions have been
identified for community-dwelling older adults after many years of
research

• Injury prevention is an important goal in populations at high risk for falls

• Comprehensive prevention plans/programs that include individual risk

assessment & individualized multi-component/multi-faceted
intervention approaches are the most effective in reducing falls & fall
risks
Thank You