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FALLS AND GAIT DISORDERS IN ELDERLY

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FALLS AND GAIT DISORDERS IN ELDERLY Presented by Dr Marie Makhoul Moderator Dr Nabil Naja Wednesday, March 5,2003 OBJECTIVES You should know It is a common and ... – PowerPoint PPT presentation

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Title: FALLS AND GAIT DISORDERS IN ELDERLY


1
FALLS AND GAIT DISORDERS IN ELDERLY
  • Presented by Dr Marie Makhoul
  • Moderator Dr Nabil Naja
  • Wednesday, March 5,2003

2
OBJECTIVES
  • You should know
  • It is a common and serious problem
  • How to evaluate an old patient after a fall
  • The principles of management of fallers

3
EPIDEMIOLOGY
  • The number of falls increases with age. The
    annual incidence is 30 over 65 years of ageand
    50 over 80.
  • Falls are among the major causes of morbidity
  • 5-15?Major trauma
  • 6? Fractures
  • 1-2?Hip fractures(osteoporosis)

4
EPIDEMIOLOGY
  • Hospital stays are almost twice
  • They experienced a greater functional decline in
    ADL,physical and social activities
  • Trauma is the fifth leading cause of death in
    elderly and Falls account for 2/3 of these
  • Syndrome post-chute

5
NORMAL AGE-RELATED CHANGES
  • GAIT
  • Decline in Velocity(speed) about 15 per decade
    because of shorter steps.
  • Cadence (rhythm) does not change with age
  • Double stance(support)increase with age from 18
    to 26 .

6
NORMAL AGE-RELATED CHANGES
  • POSTURE
  • Decreased proprioception
  • Slower righting reflexes
  • Decreased muscle tone
  • Hypopallesthesia
  • Flexed posture with wide based
  • VISUAL ABILITIES

7
RISK FACTORS
  • Older age (gt75 years)
  • Housebound status
  • Living alone
  • Use of cane or walkers
  • Previous falls
  • Acute illness
  • Chronic conditions
  • Medications

8
RISK FACTORS
  • Cognitive impairment
  • Reduced vision
  • Foot problems
  • Neurological changes
  • Decreased hearing
  • Environmental hazards

9
COMMON CAUSES
  • Accident, environmental hazards
  • Gait disturbance,balance disorders,pain
  • Vertigo
  • Medications or alcohol
  • Acute illness
  • Confusion or cognitive impairment
  • Postural hypotension
  • Visual disorder
  • Central nervous disorder

10
ENVIRONNEMENTAL HAZARDS
  • Old, unstable,and low-lying furniture
  • Beds and toilets of inappropriate height
  • Unavailability of grab bars
  • Uneven stairs and inadequate railing
  • Throw rugs ,frayed carpets,cords,wires
  • Slippery floors and bathtubs
  • Inadequate lighting or glaring
  • Cracked and uneven side walks

11
EVALUATIONSCREENING
  • If known risk factors?question about falls
  • If first fall injuries,new acute illness,loss of
    consciousness,fever or abnormal blood
    pressure?immediate evaluation
  • If recurrent falls (gt2/6 months)? evaluation for
    treatable causes

12
EVALUATIONHISTORY
  • Determine
  • possible causes of falling
  • specific risk factors
  • impairment that contribute to it

13
HISTORY
  • Ask about
  • -the circumstances of the fall
  • - the seriousness of the fall
  • -witnesses
  • -injuries
  • -previous falls

14
EVALUATION PHYSICAL EXAM
  • Focus on common problems
  • vital signs, cardiovascular, neurological,
    musculosqueletic exam, foot exam.
  • Recognize the complications of trauma
    hematoma, fractures

15
PHYSICAL EXAM
  • Gait and balance testing
  • gait testing
  • Up Go test
  • Get-up and gotest
  • One leg balance
  • Retropulsion test
  • Tinetti test
  • ADL IADL
  • Home visit for assessment if possible

16
MANAGEMENT PREVENTION
  • Eliminate environmental hazards, foot problems
  • Improve home support, family
  • Provide opportunities for socialization
  • Modify medications,prevent postural hypotension
  • Modification of lifestyle nutrition,..
  • Provide balance training, gait training
  • Treat pain
  • Provide follow-up

17
MANAGEMENTTHERAPY
  • Assess and treat complications
  • Treat underlying conditions
  • Provide physical therapy and education
  • Gait retraining
  • Muscle strengthening
  • Use of assistive devices
  • Adaptive behaviors

18
THERAPY
  • If recurrent falls use of protectors(hips,)
  • Alter the environment
  • Prevent Syndrome post-chute , recurrence

19
CONCLUSION
  • Falls is a common problems with high morbidity
  • One fall has multiple causes
  • We should do screening in every old patient with
    known risk factors

20
CONCLUSIONS
  • We should do a complete evaluation for falls in
    certain circumstances
  • Prevention and management should be done at
    multiple levels

21
THANK YOU FORYOUR ATTENTION
  • END
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