Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

FALL

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

• Approximately 35% to 40% of persons age 65 years and over fall

• approximately 50% of persons aged 80 years and older fall in a year.

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

injuries

• fractures, • lacerations, • head trauma, • Approximately 8% of persons aged• 65 years and older visit an emergency

department because of a fall related

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

most commonly

• hip, • pelvis, • femur, • vertebrae, • Humerus• Falls are the second leading cause of brain and

spinal cord injury in older adults

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

• Hip fractures are probably the most dreaded fall-related injury

• Can not return home or live independently • up to 20% die within a year cause of two-

thirds of the deaths

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

consequences

• Approximately 6% of all health care expenditure • Independence and quality of life. • Restricted activity for several months • Unable to get up from the ground • Risk of pneumonia, dehydration, and

rhabdomyolysis• Fear of falling occurs in at least 50% • Determinant of nursing home placement.

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

ETHIOLOGY

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

• The most important modifiable intrinsic risk factors for falls are – balance, – strength– gait impairments

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

treatment

• Postural Control Balance, or postural control, is dependent upon integration of:– visual, – Vestibular– proprioceptive– input by the central nervous system

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

vision

• Multifocal lenses • because the lower, near-vision lenses impair

distance depth perception• Cataracts, glaucoma, and macular

degeneration

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Hearing loss

• more than 50% of older people, • affect perception of and orientation to the

environment. • Vestibular function changes with age and with

diseases affecting the inner ear.

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Cognitive

• impairment caused by dementia • gait disorder. • Depression may increase fall risk because of

decreased concentration or awareness of potential environmental hazards.

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Musculoskeletal Impairments

• Muscle mass and strength decline with age, disease, and inactivity.

• Loss of lower-extremity strength, in particular ankle dorsiflexor strength,

• Weakness of hip abductors and adductors may decrease an older person’s ability to maintain balance while stepping to avoid a fall.

• Musculoskeletal diseases such as osteoarthritis can cause pain, deformity, and limited range of motion in joints, particularly in the back, hips, knees, and feet that increase the risk for falls

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Postural Hypotension

• Postural hypotension, which may result in instability, occurs in 10% to 30% of community-dwelling older persons aged 65 years and older.

• A drop in systolic blood pressure of 20 mmHg or more with change in position from lying to standing may be medication-related, caused by dehydration, or a result of age-associated changes or diseases that affect autonomic control of vascular tone.

• Postprandial hypotension may be suspected in persons complaining of dizziness or who fall after getting up from, or soon after, a meal.

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Medications may cause postural instability

• anticonvulsants and any psychotropic medication use, including sedative/hypnotics, antidepressants, short- or long-acting benzodiazepines, or neuroleptics.

• more medications has 3.3 times the risk of an adverse event as compared to someone taking four or fewer medications.

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Management of fall and prevention

Impaired balance, gait, mobility, neurologic disease

M, diagnose and treatment, PD, STROKE, NPHR,physical th., balance and gait training

E. Home safety

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Dementia DX & RX

R, supervised exercise and walking

E. Home safety

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Musculosketeltal disease M, DX & RX

Physical th., strengthening exersicse, balanceHome safety

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Sensory imparement, visial Medical impairment

Balance and gait training

Home safety

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Hearing loss, vestibular dys. M, avoid vestibulotoxic

Habitualtion exercise

Good lightening, home safety

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Properioceptive, cervical dis, neuropathy, spatial disorentation

M, DX. RX. Spondylisis, b12, diabete

Physical th.

Good lightening, appropriate foot wear, home safety

Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

Postural hypotension DX, RX

Graded pressure stocking, dorsiflexion, hand flexion exercise before arisingReduce the medication from 4