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instabilitasTRANSCRIPT
INSTABILITASDr. Suhaemi, SpPD, Finasim
STABILITAS BADAN DIPERTAHANKAN OLEH: Sistem sensorik: visus,pendengaran,vestibuler
&proprioseptif Sistem saraf pusat : merupakan respon mototrik dari
sistem sensorik Kognitif : demensia - jatuh Muskuloskeletal : murni milik lansia -- gangg. Gait.
Gangg.gait terjadi krn : penurunan ROM penurunan kekuatan otot kelemahan extremitas
bwh, perpenjangan waktu
reaksi kerusakan persepsi dalam, peningkatan postural sway
FAKTOR RISIKO
Intrinsik : Kondisi fisik dan neuropsikiatrik Penurunan visus dan pendengaran Perubahan neuromuskuler, gait dan
reflek postural karena proses menua Ekstrinsik : Obat-obatan yang diminum Alat bantu jalan Lingkungan yang tidak mendukung
FAKTOR RISIKO
Intrinsik : Kondisi fisik dan neuropsikiatrik Penurunan visus dan pendengaran Perubahan neuromuskuler, gait dan
reflek postural karena proses menua Ekstrinsik : Obat-obatan yang diminum Alat bantu jalan Lingkungan yang tidak mendukung
PENYEBAB JATUH PADA LANSIA
Kecelakaan Nyeri kepala mendadak dan atau vertigo Hipotensi orthostatik : hipovolumia,disfungsi
otonom,preload menurun , obat , lama berbaring, post prandial
Obat-obatan : a.hipertensi, a.depresan, a. psikotik, OAD, allkohol
Proses penyakit yang spesifik : Kardiovask : aritmia, AMI, stenosis a
Neurologi : TIA, stroke, kejang dll
. Idiopatik
Sinkope : Drop attack, penurunan darah ke otak mendadak, terbakar
matahari.
FAKTOR SITUASIONAL
AKTIVITAS : - biasa ( berjalan, naik/turun trap, ganti posisi ,dll ) - imobil ( tidak mendapat bantuan )
LINGKUNGAN : 70 % dirumah, 10 % ditangga PENYAKIT AKUT : - dizzines/ sinkope - eksaserbasi akut
asma/nyeri
KOMPLIKASI
Perlukaan : - jaringan lunak ( lecet,sobek)
- patah tulang ( kolum femur )
- subdural hematom Perawatan rumah sakit : imobilisasi,
iatrogenik Disabilitas : akibat perlukaan, tak
percaya diri Risiko masuk panti jompo Mati
Penatalaksanaan:
Pencegahan : - identifikasi dan eliminir f.risiko
-penilaian keseimbangan/gait
-mengatur/mengatasi f.situasi
Pendekatan diagnostik : assesment geriatri
Pengobatan
Gait Abnormalities and Falls
Gait Abnormalities and Falls
Gait Abnormalities and Falls
Falling: A Geriatric Syndrome
30% of persons 65+ fall at home each year
50% of persons 80+ fall at home each year
66% of fallers will fall again in six months
If an elder is hospitalized due to a fall, only 50% will be alive in a year
Falls are common in the hospitalized, most on the night of admission
Falls result in 250,000 hip fractures per year
Geriatrics 12
Complications of Falls
Medical Fractures Subdural hematoma Sprains, bruises, hematomas,
lacerations Psychological
FFF (3F syndrome): Fear of further falling:
Decreased confidence isolation and withdrawal depression reluctance to go outdoors
Geriatrics 13
Complications of Falls (Cont’d)
Social Loss of independence Risk of nursing home placement
Increased immobilization Further loss of muscle tone and strength DVT/pulmonary embolism Hypothermia Dehydration Osteoporosis Pulmonary infections
Geriatrics 14
Medical Risk Factors for Falls
Poor vision: cataracts, glaucoma,macular degeneration
CV: postural hypotension, syncope, arrhythmias, drop attacks
Lower extremity dysfunction: arthritis, weakness, foot problems, peripheral neuropathy
Gait and Balance: CVA, Parkinson’s, myelopathy, cerebellar disorders
Geriatrics 15
Types of Falls:Intrinsic vs. Extrinsic
Intrinsic factors: Changes in postural control:
Decreased proprioception, righting reflexes, muscle tone and strength; increased postural sway
Decreased foot swing height, slower gait Decreased depth perception, clarity, dark
adaptation, color sensitivity, visual fields; Increased sensitivity to glare
Geriatrics 16
Types of Falls (Cont’d)
Extrinsic factors Poor lighting Objects on the floor
(clutter, pets, throw rugs) Unstable furniture Poor or absent railings Low beds or low toilet seats
Geriatrics 17
UCSF Division of Geriatrics Primary Care Lecture Series May 2001
Fractures with Hip Protectors 2.1% per year vs. 4.6% per year
(p<.01) 40 patients needed to be treated with
hip protector for 1 year to prevent one fracture
2.4% of falls resulted in hip fracture when not wearing protector
0.4% resulted in hip fracture when wearing protector (80% risk reduction)
But patient acceptance lowKannus. NEJM;2000;343;1506-1513
UCSF Division of Geriatrics Primary Care Lecture Series May 2001
www.hipsavers.com
CDC Fall Prevention Recommendations: the 4 Pearls
Regular exercise Medication review Vision exams Home safety evaluation
Common Types of Fractures
Forearm (Wrist) Fracture Spine Fracture Hip Fracture (pelvis, hip, femur) Ankle Fracture Upper arm, forearms, hand
Fragile Bone
Osteoporosis, or brittle bones Fall induced fractures
Normal Bone Normal Bone Osteoporotic BoneOsteoporotic Bone
Dempster et al., JBMR 1986
Assistant Devices
Hip pads Mobility aids
Cane Walkers Wheelchairs
Bathroom aids Raised toilet seats Grab bars