Falling in older adults is a significant cause of morbidity and mortality and is an important class of preventable injuries. The causes of falling in old age are often multifactorial, and may require a good multidisciplinary approach to treating ongoing injuries and to prevent future falls. Falls include falling from a standing position, or from open positions such as stairs or stairs. The severity of the injury is generally related to the height of the fall. The state of the ground where the victim falls is also important, the harder surface causes more severe injury. Waterfalls can be prevented by ensuring that the carpet is bent downward, objects such as power lines are not in a person's path, hearing and vision are optimized, dizziness is minimized, alcohol intake is moderated and that shoes have low heels or rubber soles.
A review of clinical trial evidence by the European Food Safety Authority resulted in the recommendation that people over the age of 60 should supplement diet with vitamin D to reduce the risk of falls and fractures. Falling is an important aspect of geriatric treatment.
Video Falls in older adults
Definisi
Other definitions are more inclusive and do not exclude "major intrinsic events" as fallout. Tears become a concern in medical care facilities. Fall prevention is usually a priority in health care settings.
A review of the 2006 literature identifies the need for taxonomic standardization to fall because of variations in research. Prevention Falls Falls Europe Europe (ProFane) taxonomy for definition and reporting fall aims to alleviate this problem. ProFane recommends that fall be defined as "an unexpected event in which participants come to rest on the ground, floor, or lower level." The ProFane taxonomy is currently used as a framework for assessing research-related research falls in Cochrane Systematic Reviews.
Maps Falls in older adults
Signs and symptoms
- Trauma
- Soft tissue injuries. Bilateral orbematoma orbital (two black eyes) indicates that the loggers may not be aware of the fall, because they do not manage to protect their face as they touch the ground.
- Fractures and dislocations. 5% of the fallers end up with a fracture as a result of their fall, and 1% of their femoral neck fracture.
- Get rid of atrophy and muscle wasting due to decreased physical activity during the recovery period
- Due to rest in bed
- Pneumonia
- Wound press
- Dehydration
- Hypothermia
- Fear falls
Cause
Falling is often caused by a number of factors. The loggers may live with many falling risk factors and only have problems when other factors arise. Thus, management is often adjusted to treat the factors that cause the fall, rather than all the risk factors that the patient has to fall. Risk factors can be grouped into intrinsic factors, such as disease or disease. External or extrinsic factors include environments and ways that can encourage or prevent fall accidents. Factors such as lighting and lighting, personal aid equipment and floor traction are all important in the prevention of falls.
Intrinsic factor
- Balance and Gait
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- As a result of stroke, Parkinsonism, changes in arthritis, neuropathy, neuromuscular disease or vestibular disease.
- Problem of Visual and Motor Reaction Time
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- Extended reaction time will delay response and compensate for standing or walking imbalances, increasing the likelihood of falling.
- Drugs
- Polypharmacy is common in older people
- Sedatives significantly increase the risk of falling
- Cardiovascular drugs may contribute to a fall
- Visual disturbance
- Glaucoma, macular degeneration, and retinopathy increase the risk of falling Bifocals and triphoses can increase the risk of falling because the bottom of the corrective lens is optimized for a distance of about 18 inches, thus blocking a clear view of a person's foot/floor, about 4.5 to 5.5 feet below one's eyes.
- Dementia increases the chance of falling
- Orthostatic hypotension
- Postprandial hypotension
- Carotid sinus syndrome
- Neurocardiogenic syncope - the most common cause of syncope in A & E patients
- Cardiac arrhythmia
- Structural heart disease, like heart valve disease
Extrinsic Factors
- Poor lighting due to low lighting of existing lights or lights, thus preventing the identification and avoidance of hazards. Vision deteriorates with age, and extra lighting will be needed when the elderly move frequently. The strength of the bulbs used should be higher than normal, with incandescent bulbs preferred mainly because they react much faster than other types of bulbs when turned on. This is especially important when entering a room where obstacles can roam users for example, especially if it is not seen in time to prevent accidents.
- Stairs with inadequate handrails, or too steep, drive journey and fall. Steps should be widely placed with low rungs, and the surface should be slip-resistant. Softer surfaces can help limit the impact of injury to bearing loads.
- A door with adequate headroom so the user's head is not on the doorstep. The low headroom door (less than 2 meters) is common in older homes and cottages for example.
- Carpet/floor surfaces with low friction, causing poor appeal and individual instability. All surfaces should have high friction coefficients with shoe soles.
- Clothes/footwear not fitted properly, shoes with low friction on the floor. Rubber soles with ribs typically have high friction coefficients, so they are preferred for most purposes. Clothes should suit users well, with no lagging parts (hems falling under the heels and loose straps) that can get stuck with a hitch
- Lack of tools/aids such as walking sticks or walking frames, such as Zimmer frames that can improve user stability. Grab bars and hanging ropes should be supplied quite a lot, especially in critical areas where users may be vulnerable.
Diagnosis
When assessing a person who has fallen, it is important to try to get an eyewitness account of the incident. Since loggers may have lost consciousness, they may not provide an accurate description of the fall. However, in practice, these eyewitness accounts are often not available. It is also important to remember that 30% of parents who are cognitively intact can not remember the fall three months later. Important points of question:
- Visual motor reaction time
- Fall frequency
- The effectiveness of the "parachute" corrective response to move the hands and arms to "break" the fall
- Eyewitness reports
- Related features
- Risk factors for falling
- legal and illegal drug interactions
- Tranquilizers and alcohol consumption
- Assess the use of the right ore and safe walker aids or walkers
Prevention
Fall prevention is done first with a detailed assessment of fall risk.
A large amount of evidence suggests that efforts that include exercise reduce the risk of falling.
Possible interventions to prevent falls include:
- Provision of security devices such as grip handles, friction floors and high footwear, as well as low night power lighting
- Regular exercise - strengthening exercises of the lower extremities to increase muscle strength. Other forms of exercise, such as exercise that involves gait, balance, coordination, and functional tasks, can also help improve balance in older adults.
- The 2014 review concludes that sports interventions can reduce the fear of falling (FOF) in adults who live in communities immediately after the intervention, without evidence of long-term effects.
- Overview-monitoring of medicines and ongoing medical problems
- Supplementation with vitamin D is not recommended in those without vitamin D deficiency.
- Handle environmental issues, including an overview of the current living conditions (list of actions)
Interventions to minimize falling consequences:
- Hip protectors - may reduce the likelihood of a slight hip fracture, although it may increase the likelihood of small hip fractures in older adults living in a nursing facility. Little or no effects are reported on other fractures or falling
- Treatment for osteoporosis
Hospital
People hospitalized are at risk of falling. A randomized trial showed that the use of aids was reduced in the hospital. The nurse completed a valid fall risk assessment scale. From that, the software package develops special fall prevention interventions to address the patient's specific determinants of fall risk. The package also has a poster bed with short text and accompanying icons, patient education handouts, and care plans, all communicating patient-specific warnings to key stakeholders.
Screening
The American Geriatrics Society (AGS)/British Geriatrics Society (BGS) recommends that all older adults should be screened for "falling within the past year". Falling history is the strongest risk factor associated with subsequent fallout. Older people who have experienced at least one fall in the last 6 months, or who believe that they may fall in the coming months, should be evaluated with the aim of reducing the risk of recurrent falls.
Many health institutions in the US have developed a filtering questionnaire. Investigations include walking and balance difficulties, the use of medications to help sleep/mood, loss of sensation in the feet, vision problems, fear of falling, and use of walking aids.
Older adults who report falls should be asked about their circumstances and frequency to assess the risks of gait and balance that might be compromised. Risk assessment falls by doctors to include history, physical examination, functional ability, and environment.
Epidemiology
Incidence of falls increases progressively with age. According to existing scientific literature, about one-third of the elderly population experience one or more falls every year, while 10% experience falls several times each year. The risk is greater in people older than 80 years, where the annual incidence of falls can reach 50%.
History
Researchers have tried to make a consensus definition of decline since the 1980s. Tinneti et al. defines fall as "an event that results in a person coming to rest inadvertently on the ground or lower level, not as a result of a major intrinsic event (such as a stroke) or enormous danger."
Economy
The impact of health care and falling costs on older adults has significantly increased worldwide. Falling costs are categorized into 2 aspects: direct costs and indirect costs.
Direct costs are what is paid by patients and insurance companies to treat injuries related to falls. This includes fees for hospitals and nursing homes, doctors and other professional services, rehabilitation, community-based services, use of medical equipment, prescription drugs, home-made changes and insurance processing.
Indirect costs include loss of family caregiver productivity and long-term effects of fall injuries such as disability, dependence on others and reduced quality of life.
In the United States alone, the total cost of injury to people 65 and older is $ 31 billion by 2015. The cost includes millions of hospital emergency room visits for non-fatal injuries and over 800,000 hospitalizations. By 2030, the annual number of falling injuries is estimated to be 74 million older adults.
Research
Furthermore, a recent systematic review has shown that performing multiple task tests (eg, combining tasks with numerical tasks) can help predict which people are at higher risk of falling.
References
External links
- Morse Fall Assessment Assessment tool for determining and measuring people as low, medium, and high risk to fall.
- Old Adult Falls - Centers for Disease Control and Prevention
Source of the article : Wikipedia
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