Falls In The Elderly

Annually plunge 30-40% of elderly people who live unsupervised, and 50% of nursing home residents. In the US, falls are the leading cause of accidental death and the seventh most common cause of death in ? 65 years; 75% of deaths from falls occur in 13% of the population who are ? 65 years old. The medical costs alone for the supply of fall injuries totaled $ 31 billion in 2015 and will undoubtedly increase.

A crash is defined as a person comes to rest on the floor or any other lower level; sometimes encounters a body part against an object that interrupts the fall. Typically, events that are caused by acute diseases (eg., Stroke, seizure) or overwhelming dangers in the environment (eg. As being hit by a moving object) are caused, not specified as falls. Annually plunge 30-40% of elderly people who live unsupervised, and 50% of nursing home residents. In the US, falls are the leading cause of accidental death and the seventh most common cause of death in ? 65 years; 75% of deaths from falls occur in 13% of the population who are ? 65 years old. The medical costs alone for the supply of fall injuries totaled $ 31 billion in 2015 and will undoubtedly increase. Falls threaten the independence of elderly people and causing a cascade of personal and socio-economic consequences. However, doctors often notice falls not in patients who present without injury, as a routine history and physical examination usually includes no specific clarification of falls. Many older people report reluctant from a fall because they associate falls with aging or because they fear being later restricted in their activities or institutionalized. Etiology The best predictor of falls is a preceding fall. However, falls in older people rarely have a single cause or a risk factor. A fall is usually based on a complex interaction of the following factors: Intrinsic factors (age-related loss of function, diseases and adverse effects of medication) Extrinsic factors (risks in the area) situational factors (related to the activity being performed, for example, for. toilet rush) Intrinsic factors Age-related changes can affect the systems that are involved in the maintenance of balance and stability (eg. as when standing, walking or sitting) and increase the risk of falling. Visual acuity, contrast sensitivity and depth perception dark adaptation decrease. to produce changes in the activation pattern of muscles and the ability enough muscle strength and speed, can affect the ability to maintain balance in response to disturbance or restore (z. B. Enter an uneven surface while being pushed). In fact, any kind of muscle weakness is an important predictor of falls. Chronic and acute diseases (see table: diseases that contribute to the risk of falling) and drugs (see table: drugs that contribute to the risk of falling) are important risk factors for falls. The risk of falling increases with the number of drugs taken. Psychotropic drugs are the drugs that are reported most frequently that they have the risk of falls and injuries from falls erhöhen.Extrinsische factors environmental factors can increase the risk of falling isolated or, more importantly, interact with intrinsic factors. The risk is highest when the environment a higher postural control and mobility needs (eg. As when walking on slippery surfaces) and if the environment is not familiar (z. B. when moving to a new home) .Situative Factors Certain activities or decisions can increase the risk of falls and injuries from falls. Examples are: walking and talking simultaneously or distraction of multitasking, only to notice a hazard in the environment (. Such as a curb or step), rushing into the bathroom (insbeondere when one is insufficient not fully awake or lighting at night ) and to hurry abzunehmen.Komplikationen the phone falls, particularly repeated drops, increase the risk of injury, hospitalization and death, v. a. have in older people who are frail and pre-existing co-morbidities (eg. as osteoporosis) and deficits in activities of daily living (eg. as incontinence). Longer-term complications include decreased physical functioning, fear of falling, and institutionalization. supposedly go> 40% of nursing home admissions on falls back .. More than 50% of falls by older people result in injury. Although most injuries (z. B. bruises, abrasions) are not serious, make fall-related injuries is about 5% of hospitalizations in patients ? 65 years of. About 5% of falls result in fractures of the upper arm, wrist or pelvis. About 2% of falls result in hip fracture. Other serious injuries (eg. B. head and internal injuries, cuts) occur in approximately 10% of cases. Some fall-related injuries are fatal. About 5% of older people with hip fractures die in the hospital. The overall mortality rate within 12 months after a hip fracture ranges from 18-33%. About half of the elderly people who fall, can not get up without help. > 2 hours to lie on the ground after a fall, increasing the risk of dehydration, pressure sores, rhabdomyolysis, hypothermia and pneumonia. Functioning and quality of life can deteriorate dramatically after a fall; at least 50% of older people who were able to walk in front of a hip fracture, reaching its former level of mobility no longer. After a fall, older people fear to plunge again; Thus, sometimes the mobility limits because the confidence is lost. Some people may even avoid certain activities because of this fear (z. B. shopping, cleaning). Decreased activity may increase joint stiffness and weakness, which further reduces the mobility. Diseases that contribute to the risk of falling functional impairment disease blood pressure regulation anemia arrhythmias cardioinhibitory carotid sinus hypersensitivity COPD dehydration infections (eg. As pneumonia, sepsis) metabolic disorders (eg., Diabetes, thyroid disease, hypoglycemia, hyperosmolar states) Neurokardiogenie inhibition of micturition Orthostase- syndrome Postprandial hypotension valvular heart disease Central processing delirium dementia apoplexy Gang arthritis deformities muscle weakness postural and neuromotor function cerebellar degeneration myelopathy (eg. B. Vertebrobasilar due to cervical or lumbar spondylosis) Parkinson’s disease Peripheral neuropathy stroke insufficiency proprioception Peripheral neuropathy (z. B. due to diabetes mellitus) vitamin B12Mangel otolaryngological function Acute labyrinthitis Benign paroxysmal positional vertigo hearing M. Meniere See cataract glaucoma macular degeneration (age-related ) drugs that the risk of falling b eitragen drugs mechanism aminoglycosides Direct vestibular damage analgesics (particularly opioids) Reduced alertness or slow central processing antiarrhythmics Limited cerebral blood flow anticholinergics confusion / delirium Limited antihypertensives (especially vasodilators) cerebral blood flow antipsychotics extrapyramidal syndromes, other anti-adrenergic effects, reduced attention, or slowed central processing diuretics (especially in dehydrated patients) Limited cerebral circulation loop diuretics (high dose) Direct vestibular damage psychotropic drugs (especially antidepressants, antipsychotics and benzodiazepines) V ermin-made attention or slow central processing assessment Clinical evaluation performance tests Sometimes laboratory tests after treatment of acute injuries targets the exam on identifying risk factors and appropriate interventions in order to reduce the risk of future falls and fall-related injuries (1, 2). Some falls are noticed immediately because of an obvious fall-related injury or concern about a possible violation. Because older people often do not report crashes or mobility problems, they should be at least once interviewed jährllich over falls. Patients who report a single fall, must be judged on a balance or gait disturbance with the base-stand walking test. During the test, patients are observed as they get up from a standard armchair, 3 m walk straight, turn around, go back to the chair and sit down again. When observing a weakness of the lower extremity, imbalance while standing or sitting or unsteady gait can be recognized. Sometimes the test is timed. A time of> 12 s indicates a significantly increased risk of falling. Patients who need a more comprehensive assessment of risk factors for falls are patients who have difficulty with the standing-walking test, patients who reported during the screening over repeated drops patients who are judged by a recent fall (after acute injury identified were and treated) history and physical examination is a more comprehensive assessment of risk factors is required, the focus is on identifying intrinsic, extrinsic and situational factors that can be selectively reduced by appropriate interventions. Patients are asked about the recent fall or falls, followed by more specific questions about when and where a fall has occurred and what they did open questions. Witnesses are asked the same questions. Patients should be asked if they had harbingers or associated symptoms (eg. As palpitations, shortness of breath, chest pain, dizziness, drowsiness), and whether they had lost consciousness. Patients should also be asked if obvious extrinsic or situational factors were involved. The history should include questions about past and current medical problems, the use of prescription drugs and over the counter drugs and consumption of alcohol. Because the elimination of all risks for future downfall may not be possible, patients should be asked if they could get up after a fall without help and whether any violations have occurred; the goal is to reduce the risk of complications due to future falls. The physical examination should be so comprehensive that obvious intrinsic causes of falls are excluded. If the fall has recently occurred, the temperature should be measured to determine if fever was a factor. Heart rate and rhythm should be determined in order to identify an obvious bradycardia, tachycardia at rest or irregular rhythms. The exclusion of orthostatic hypotension blood pressure in the supine position should be measured and after the patients 1 and 3 have been minutes. A auscultation may reveal many types of heart valve disease. In determining the visual acuity patients should wear their usual visual aids if necessary. Variations in visual acuity should be reason for a more detailed eye examination by an optometrist or ophthalmologist. Neck, spine and extremities (especially the legs and feet) should be examined for weakness, deformities, pain and loss of motion. A neurological examination should be carried out; it includes the testing of muscle strength and tone, sensor (incl. proprioception), coordination (incl. cerebellar function), balance while standing and gait. Using the Romberg test (in which the patient with feet together and eyes both open and closed, are) the reason postural control and proprioceptive and vestibular system be reviewed. Tests for the detection of higher equilibrium functions are one-legged stance and tandem gear. If the patient can see on one leg 10 to stand with their eyes open, and with an accurate 3-m-tandem gear, a disorder of the intrinsic postural control should be minimal. Physicians should vestibular location function (eg. As the Dix-Hallpike maneuver nystagmus) and mental status evaluieren.Leistungstests to the performance-based assessment of the mobility and the standing-walking test on time disorders of balance and stability while walking and other movements notice that indicate an increased risk of falls. These tests are especially helpful when the patient difficulty base-stand Walk Test hatte.Labortests There is no standard diagnosis. The tests should be based on the history and physical examination and usually help rule out various causes: A blood count for anemia or leukocytosis blood glucose monitoring for hypoglycemia or hyperglycemia electrolyte measurement for dewatering tests such as ECG, cardiac monitoring while walking and echocardiography are recommended only if a cardiac cause is suspected. Karotismassage under controlled conditions (iv access and monitoring of cardiac function) was proposed to establish a carotid hypersensitivity and to identify the patients who could ultimately respond to pacing. Spinal X-ray examination and cranial CT or MRI are indicated only if the patient history and physical examination identify new neurological abnormalities lassen.Hinweise for evaluation 1. National Institute for Health and Care Excellence: Falls in older people: Assessing risk and prevention (Clinical Guideline [ CG] 161), 2013. 2. US Preventive Services Task Force (USPSTF): Final Evidence Summary: If prevention in older adults: Counseling and preventive medication. Ann Intern Med, 2012. Prevention The focus should be on preventing or reducing the number of falls and fall-related injuries and complications, with the functioning and independence of the patient is to be obtained as possible. In periodic physical or health examination, patients should be questioned about events in the past year and problems with balance or walking ability (1, 2). Patients who report a single fall and have no difficulty with balance or the hallway when standing-walking test or a similar test should provide general information to reduce the risk of falls. This should include how safe to use drugs and to reduce risks in the area (see table: Checklist for domestic hazards that increase the risk of falls). Patients who report more than a fall or a problem with balance or transition should receive overthrow evaluation in order to reduce the risk factors and potential risk to identify. For more information, the prevention of falls in older people concerning, s. Cochrane review abstract interventions for Preventing case in older people living in the community, the American Geriatrics Society / British Geriatrics Society guideline for the prevention of case in older persons and the British Medical Journal interventions for the prevention of case in older adults. Checklist for domestic hazards that increase the risk of falling danger localization correction Rational General household lighting to dark providing adequate lighting in all areas improves visual acuity and contrast sensitivity to direct, hidden reducing the glare of evenly distributing tem light, indirect light or transmitted light protection improves visual acuity and contrast sensitivity inaccessible light switch providing night lights or activated by contact lamps install switches that are immediately accessible upon entering a room, or motion sensors to turn the lamps reduces the risk of over unseen stumbling obstacles or to encounter in a dark room carpets, rugs, linoleum Torn repair or replace carpets zerrissenener Re duced, the risk of stumbling and slipping, v. a. for people with foot problems Slippery providing rugs with non-slip bottom Reduces the risk of slipping Wavy edges of tacking or sticking of carpets or linoleum to prevent it reduces roll up replacing carpets or linoleum, the risk of tripping chairs, tables and other furnishings Unstable providing of furniture that are strong enough u m to support the weight of a person on table edges or arms and back supports itself No use of chairs that have wheels or are pivotally repair of loose chair legs Increases support for people with balance disorders and helps in converting chairs without armrests providing chairs with armrests, which are extended forward and getting up or sitting down leverage offer Helps people with proximal muscle weakness and when transferring Built-way arrangement of furniture without blocking the paths removal of clutter in corridors Reduces the risk of tripping or bumping into obstacles, making it easier and safer to move home, v. a. for people with limited peripheral vision cables and wires lying in the way of attaching the cable above the ground or laying under the flooring Reduces the risk of tripping kitchen cabinets, shelves Reduces too high storage of frequently used items on the waist fastening shelves and cabinets in an accessible level the risk of falls by frequent routes or climbing on ladders or chairs Wet floors or waxed Place a rubber mat on the floor in front of the sink wearing shoes with rubber soles in the kitchen, use of non-skid wax Reduces the risk of slipping, v. a. for people with walking problems Bathroom Bath or Shower Slippery bath or shower floor laying non-slip strips or a rubber mat use of slippers or a shower stool (a shower stool allows people with balance disorders to shower while sitting) Reduces the risk on the wet bath or shower floor slipping necessity to use the tub edge to support or when moving Install a grab handle in the shower, install a portable support handle on the When side take away the handle traveling Helps in converting towel rack, sink Not stable enough to serve as a support during relocation of toilet, bathtub or shower attachment of handrails wall anchors Helps in converting toilet seat too low using a raised toilet seat Helps in converting to and from the toilet doors locks En tfernen of castles in bathroom doors or use of locks that can be opened from both sides of the door Allows entering other people if a person falls stairs steps Reduces too high correct the step height to <15 cm slipping height the risk v. a. If difficulties for people with handrails absence installing and firm anchoring of railings on both sides of the staircase using cylindrical rails, which are laid at a distance of 2.5-5 cm from the wall provide support and make it possible to grip the handrails with both hands too short and ends of the railing not recognizable extension on the upper and lower level out and bending the ends inwards Indicates that the upper or lower level has been reached Configuration too steep or too long they install if possible landings on stairs or choose a house with a staircase landing Provide a place to rest, v. a. Safe for people with heart or lung disease Physical state Slippery attaching non-slip treads on all levels Prevents slipping lighting Poorly fitting a sufficient lighting at the top and bottom of the stairs provision of night lights or refelktierenden tape to mark the stages clearly outline the position of the steps v. a. for people with visual or cognitive limitations physical therapy and exercise patients who have fallen more than once or who have problems with the entrance tests for balance and gait, should be referred to physiotherapy or an exercise program. Physiotherapy and exercise programs can be done at home if patient mobility is limited. Physiotherapists adapt the training programs to improve balance and gait and correct specific problems that contribute to the risk of falling. General training programs in health or community facilities can also improve balance and gait. Tai Chi can be,. B. be effective and be operated alone or in groups. The most effective training programs in order to reduce the risk of falls, are those that are adapted to the deficits of patients are by a trained professional provided Possess sufficient balance Herausforderuns component (balance challenge component) are provided over the long term (eg. B . ? 4 mo) Viele Seniorenzentren, der christliche Verein junger Menschen (CVJM) oder andere Gesundheitszentren bieten kostenlose oder kostengünstige, auf Senioren zugeschnittene Übungen in Gruppen an, und diese Gruppen können bei der Erreichbarkeit und der Einhaltung hilfreich sein. Die Einsparungen durch verminderte sturzbedingte Kosten übersteigen die Kosten dieser Programme (3).Hilfsmittel Einige Patienten profitieren von Einsatz eines Hilfsmittels (z. B. Gehstock, Gehbock). Gehstöcke können für Patienten mit minimalen einseitigen Muskel- oder Gelenkproblemen ausreichen, Gehböcke, v. a. Rollatoren, sind dagegen besser geeignet für Patienten mit einem erhöhten Sturzrisiko, das einer beidseitigen Beinschwäche oder Koordinationsstörungen zuzuschreiben ist (Rollatoren können für Patienten, die sie nicht richtig steuern können, gefährlich sein). Physiotherapeuten können helfen, den Sitz oder die Größe der Geräte anzupassen und den Patienten erklären, wie sie zu benutzen sind ( Therapeutische und unterstützende Hilfsmittel).Medizinisches Management Medikamente, die das Sturzrisiko erhöhen können, sollten abgesetzt oder die Dosierung auf die niedrigste wirksame Dosis eingestellt werden (siehe Tabelle: Medikamente, die zum Sturzrisiko beitragen). Patienten sollten auf Osteoporose überprüft und, falls eine Osteoporose diagnostiziert wird, behandelt werden, um das Frakturrisiko bei zukünftigen Stürzen zu reduzieren. Wenn eine andere spezifische Störung als Risikofaktor identifiziert wird, sind gezielte Eingriffe erforderlich. Medikamente und physikalische Therapie können z. B. das Risiko für Patienten mit M. Parkinson verringern. Vitamin D, insbesondere bei Einnahme zusammen mti Kalzium, kann das Sturzrisiko senken, insbesondere bei Patienten mit erniedrigem Vitamin-D-Spiegel im Blut. Schmerzbehandlung, physikalische Therapie und manchmal Gelenkersatz können das Risiko für Patienten mit Arthritis reduzieren. Eine Umstellung auf geeignete Brillengläser (Einstärkengläser statt bi- oder trifokaler Brillen) oder eine Operation, insbesondere zur Kataraktentfernung, kann sehbehinderten Patienten helfen.Umgebungsanpassung Die Korrektur von Gefährdungen

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