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Falls Prevention York Region Health Department

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Frail older adults have complex problems. Most of my patients have a comorbid ... Ignition failure frozen or glued foot. Deficits in stepping with shuffling ... – PowerPoint PPT presentation

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Title: Falls Prevention York Region Health Department


1
Falls PreventionYork Region Health Department
  • A Psychiatrists Perspective
  • May 14, 2007
  • Dr. Ian Ferguson

2
Geriatric Psychiatry and Movement
  • Impaired mobility is a reflection of frailty
  • Frail older adults have complex problems
  • Most of my patients have a comorbid medical or
    neurologic disorder
  • The decisions made by frail older adults are
    often life changing
  • An old age psychiatrist must have a
    multidisciplinary perspective

3
Points of Intersection
  • Inpatient GARU, rehab, CCC, palliative
  • Outpatient psychogeriatric clinic
  • Community
  • Home
  • Assistive Living
  • RH
  • LTCF

4
Inpatient
  • Mental Status
  • Cognitive Status
  • Psychopharmacology
  • Co-morbid conditions
  • Discharge Planning
  • Risk assessment
  • Ethics

5
Psychogeriatric Clinic
  • What does the observed difficulty with movement
    tell us?
  • Probable Gait Apraxia in absence of other
    neurologic pathology
  • problems with IADL and ADL
  • Risk for falls
  • Cerebrovascular pathology
  • Impairment of frontal lobe function

6
Gait Apraxia
  • Defn
  • the loss of monitoring of the automatic
    implementation of gait mechanisms
  • Synonyms HLGD, frontal ataxia.
  • Includes Trunk, Stance, Gait
  • Dissociation between Gait Apraxia and ideomotor
    apraxia, facial apraxia, and utilisation apraxia

7
Trunk
  • Problems with
  • Transfers to and from sitting
  • Transfers to and from lying down
  • Turning around while standing
  • Rolling over in bed

8
Stance
  • Problems
  • Balance while standing, walking or negotiating
    turns
  • Loss of anticipatory and reactive postural
    responses resulting in falls

9
Gait
  • Problems
  • Ignition failure frozen or glued foot
  • Deficits in stepping with shuffling
  • Obstructive leg crossing or leg hypokinesia
  • Temporary arrests of walking
  • Difficulty with stopping and turning
  • Cant walk and talk

10
Community -Environment
  • Home
  • furniture walking
  • Hoarding
  • Safety vs independence
  • Ability to manage ADLs and IADLs

11
Community - Environment
  • LTCF
  • Layout and structure of the rooms and units
  • Staffing
  • Psychosocial variables
  • Interpersonal
  • milieu

12
Summary
  • Gait impairment, disequilibrium, and falls inform
    us about
  • Possible neuropathology
  • Impairment in other areas of function
  • Increased frailty
  • Necessity of a multidisciplinary view of a
    complex situation
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