1. FALLS AND GAIT DISORDERS IN ELDERLY Presented by Dr Marie Makhoul Moderator Dr Nabil Naja Wednesday, March 5,2003

2. 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

3. 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)

4. 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

5. 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%.

6. 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

7. 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

8. 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 :

9. 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

10. 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

11. March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut 11 EVALUATION SCREENING 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

12. 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 EVALUATION HISTORY

13. 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

14. 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…

15. 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

16. 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

17. March 5, 2003 Dar Al-Ajaza Al-Islamia Hospital in Beirut 17 MANAGEMENT THERAPY  Assess and treat complications  Treat underlying conditions  Provide physical therapy and education: Gait retraining Muscle strengthening Use of assistive devices Adaptive behaviors

18. 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

19. 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

20. 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

21. THANK YOU FOR YOUR ATTENTION END