FALLS AND GAIT DISORDERS IN ELDERLY

Presented by Dr Marie Makhoul

Moderator Dr Nabil Naja

Wednesday, March 5,2003

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

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

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

3

EPIDEMIOLOGY The number of falls increases with age.

The annual incidence is 30% over 65 years of age;and 50% over 80.

Falls are among the major causes of morbidity:

5-15%→Major trauma 6%→ Fractures 1-2%→Hip fractures(osteoporosis)

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

4

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”

EPIDEMIOLOGY

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

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% .

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

6

NORMAL AGE-RELATED CHANGES POSTURE:

Decreased proprioception

Slower righting reflexes

Decreased muscle tone

Hypopallesthesia

Flexed posture with wide based VISUAL ABILITIES

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

7

RISK FACTORS : Older age (>75 years) Housebound status Living alone Use of cane or walkers Previous falls Acute illness Chronic conditions Medications

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

8

Cognitive impairment Reduced vision Foot problems Neurological changes Decreased hearing Environmental hazards

RISK FACTORS :

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

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

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

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

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

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 (>2/6 months)→ evaluation for treatable causes

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

12

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

EVALUATIONHISTORY

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

13

HISTORY

Ask about

-the circumstances of the fall

- the seriousness of the fall

-witnesses

-injuries

-previous falls

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

14

EVALUATION PHYSICAL EXAM

Focus on common problems:

vital signs, cardiovascular, neurological, musculosqueletic exam, foot exam.

Recognize the complications of trauma: hematoma, fractures…

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

15

PHYSICAL EXAM Gait and balance testing: gait testing “Up & Go “test “Get-up and go”test One leg balance Retropulsion test Tinetti test ADL ;IADL Home visit for assessment if possible

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

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

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

17

MANAGEMENTTHERAPY Assess and treat complications Treat underlying conditions Provide physical therapy and education:

Gait retraining

Muscle strengthening

Use of assistive devices

Adaptive behaviors

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

18

THERAPY

If recurrent falls: use of protectors(hips,…)

Alter the environment

Prevent “Syndrome post-chute” , recurrence

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

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

March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut

20

CONCLUSIONS

We should do a complete evaluation for falls in certain circumstances

Prevention and management should be done at multiple levels

THANK YOU FORYOUR ATTENTION

END