1. Falls Prevention York Region Health Department A Psychiatrist’s Perspective May 14, 2007 Dr. Ian Ferguson

2. Geriatric Psychiatry and Movement Impaired mobility is a reflection of frailty Frail older adults have complex problems Most of my patients have a comorbid medical or neurologic disorder The decisions made by frail older adults are often life changing An old age psychiatrist must have a multidisciplinary perspective

3. Points of Intersection Inpatient – GARU, rehab, CCC, palliative Outpatient psychogeriatric clinic Community: –Home –Assistive Living –RH –LTCF

4. Inpatient Mental Status Cognitive Status Psychopharmacology Co-morbid conditions Discharge Planning –Risk assessment –Ethics

5. Psychogeriatric Clinic What does the observed difficulty with movement tell us? –Probable Gait Apraxia in absence of other neurologic pathology –problems with IADL and ADL –Risk for falls –Cerebrovascular pathology –Impairment of frontal lobe function

6. Gait Apraxia Def’n: –the loss of monitoring of the automatic implementation of gait mechanisms –Synonyms: HLGD, frontal ataxia…. –Includes: Trunk, Stance, Gait –Dissociation between Gait Apraxia and ideomotor apraxia, facial apraxia, and utilisation apraxia

7. Trunk Problems with: –Transfers to and from sitting –Transfers to and from lying down –Turning around while standing –Rolling over in bed

8. Stance Problems: –Balance while standing, walking or negotiating turns –Loss of anticipatory and reactive postural responses – resulting in falls

9. Gait Problems: –Ignition failure – frozen or glued foot –Deficits in stepping with shuffling –Obstructive leg crossing or leg hypokinesia –Temporary arrests of walking –Difficulty with stopping and turning –Can’t walk and talk

10. Community -Environment Home: –furniture walking –Hoarding –Safety vs independence –Ability to manage ADLs and IADLs

11. Community - Environment LTCF –Layout and structure of the rooms and units –Staffing –Psychosocial variables: Interpersonal milieu

12. Summary Gait impairment, disequilibrium, and falls inform us about: –Possible neuropathology –Impairment in other areas of function –Increased frailty –Necessity of a multidisciplinary view of a complex situation