in stabilit as
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instabilitasTRANSCRIPT
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INSTABILITASDr. Suhaemi, SpPD, Finasim
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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
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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
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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
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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.
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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
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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
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Penatalaksanaan:
Pencegahan : - identifikasi dan eliminir f.risiko
-penilaian keseimbangan/gait
-mengatur/mengatasi f.situasi
Pendekatan diagnostik : assesment geriatri
Pengobatan
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Gait Abnormalities and Falls
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Gait Abnormalities and Falls
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Gait Abnormalities and Falls
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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
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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
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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
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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
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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
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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
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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
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UCSF Division of Geriatrics Primary Care Lecture Series May 2001
www.hipsavers.com
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CDC Fall Prevention Recommendations: the 4 Pearls
Regular exercise Medication review Vision exams Home safety evaluation
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Common Types of Fractures
Forearm (Wrist) Fracture Spine Fracture Hip Fracture (pelvis, hip, femur) Ankle Fracture Upper arm, forearms, hand
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Fragile Bone
Osteoporosis, or brittle bones Fall induced fractures
Normal Bone Normal Bone Osteoporotic BoneOsteoporotic Bone
Dempster et al., JBMR 1986
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Assistant Devices
Hip pads Mobility aids
Cane Walkers Wheelchairs
Bathroom aids Raised toilet seats Grab bars