1. FALL Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

2. Approximately 35% to 40% of persons age 65 years and over fall approximately 50% of persons aged 80 years and older fall in a year. Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

3. injuries fractures, lacerations, head trauma, Approximately 8% of persons aged 65 years and older visit an emergency department because of a fall related Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

4. most commonly hip, pelvis, femur, vertebrae, Humerus Falls are the second leading cause of brain and spinal cord injury in older adults Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

5. Hip fractures are probably the most dreaded fall-related injury Can not return home or live independently up to 20% die within a year cause of two- thirds of the deaths Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

6. consequences Approximately 6% of all health care expenditure Independence and quality of life. Restricted activity for several months Unable to get up from the ground Risk of pneumonia, dehydration, and rhabdomyolysis Fear of falling occurs in at least 50% Determinant of nursing home placement. Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

7. ETHIOLOGY Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

9. The most important modifiable intrinsic risk factors for falls are – balance, – strength – gait impairments Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

10. treatment Postural Control Balance, or postural control, is dependent upon integration of: – visual, – Vestibular – proprioceptive – input by the central nervous system Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

11. vision Multifocal lenses because the lower, near-vision lenses impair distance depth perception Cataracts, glaucoma, and macular degeneration Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

12. Hearing loss more than 50% of older people, affect perception of and orientation to the environment. Vestibular function changes with age and with diseases affecting the inner ear. Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

13. Cognitive impairment caused by dementia gait disorder. Depression may increase fall risk because of decreased concentration or awareness of potential environmental hazards. Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

14. Musculoskeletal Impairments Muscle mass and strength decline with age, disease, and inactivity. Loss of lower-extremity strength, in particular ankle dorsiflexor strength, Weakness of hip abductors and adductors may decrease an older person’s ability to maintain balance while stepping to avoid a fall. Musculoskeletal diseases such as osteoarthritis can cause pain, deformity, and limited range of motion in joints, particularly in the back, hips, knees, and feet that increase the risk for falls Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

15. Postural Hypotension Postural hypotension, which may result in instability, occurs in 10% to 30% of community-dwelling older persons aged 65 years and older. A drop in systolic blood pressure of 20 mmHg or more with change in position from lying to standing may be medication-related, caused by dehydration, or a result of age-associated changes or diseases that affect autonomic control of vascular tone. Postprandial hypotension may be suspected in persons complaining of dizziness or who fall after getting up from, or soon after, a meal. Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

16. Medications may cause postural instability anticonvulsants and any psychotropic medication use, including sedative/hypnotics, antidepressants, short- or long-acting benzodiazepines, or neuroleptics. more medications has 3.3 times the risk of an adverse event as compared to someone taking four or fewer medications. Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

19. Management of fall and prevention Impaired balance, gait, mobility, neurologic disease M, diagnose and treatment, PD, STROKE, NPH R,physical th., balance and gait training E. Home safety Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

20. DementiaDX & RX R, supervised exercise and walking E. Home safety Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

21. Musculosketeltal diseaseM, DX & RX Physical th., strengthening exersicse, balance Home safety Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

22. Sensory imparement, visialMedical impairment Balance and gait training Home safety Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

23. Hearing loss, vestibular dys.M, avoid vestibulotoxic Habitualtion exercise Good lightening, home safety Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

24. Properioceptive, cervical dis, neuropathy, spatial disorentation M, DX. RX. Spondylisis, b12, diabete Physical th. Good lightening, appropriate foot wear, home safety Seyed Kazem Malakouti, MD,Iran University of Medical Sciences

25. Postural hypotensionDX, RX Graded pressure stocking, dorsiflexion, hand flexion exercise before arising Reduce the medication from 4 Seyed Kazem Malakouti, MD,Iran University of Medical Sciences