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Dr. SahrunInstabilitas dan Jatuh

Geriatric Giant Immobility Instability Incontinence (urinary & alvi) Intellectual impairment (MCI, Dementia) Infection (Pneumonia, etc) Impairment of hearing & vision Impaction (constipation) Isolation (depression) Inanition (malnutrition) Impecunity (poverty) Iatrogenesis Insomnia Immune deficiency ImpotenceKane, Ouslander Abrass. (from Solomon 1988), Essentials of Clinical Geriatrics.2004 . p.13-14. Epidemiology35-40% elderly fall per yearIncidence ~ ageWomen > menHazzards Geriatric Medicine . 6th ed.PENDAHULUANJatuh kualitas hidup , karena jejas jaringan, nyeri, imobilisasi, fraktur

Jatuh : ketidakmampuan untuk mempertahankan pusat gravitasi diantara kedua kaki

Strategi Postural A. Strategi pergelangan kaki B. Strategi panggul C. Strategi suspensori D. Strategi melangkah/menggapaiMEKANISME JATUHTerpeleset (slip) :berhubungan dengan gangguan ketajaman penglihatan dan koordinasibiasanya pasien akan terayun ke belakangTersandung (trip):kelemahan otot pangkal pahaberhubungan dgn gangguan proprioseptif dan gangguan visuospasialFaktor risiko intrinsikFaktor risiko ekstrinsik

INSTABILITAS JATUH The multi-factorial and interacting causes of fallsIntrinsic risk factorsGait and balance impairmentPeripheral neuropathyVestibular dysfunctionMuscle weaknessVision impairmentMedical illnessAdvanced ageImpaired ADLOrthostaticDementiadrugsExtrinsic risk factorsEnvironmental hazardPoor footwearRestraints Precipitating causesTips & slipsDrop attackSyncopeDizziness Acute medical illnessFALLRubenstein, LZ, Josephson, KR. Falls and their prevention in elderly people: What does the evidence show? Med Clin North America 2006; 90:807.FAKTOR INTRINSIKVertigo dengan berbagai penyebabSinkop, sway, drop attacks, dizzinessGangguan penglihatanGangguan pendengaranPenyakit sistemik, terut. KV dan neurologisPenyakit Parkinson, hidrosefalus tekanan normal, tu intrakranial, SDH, gangg serebelumGangguan muskuloskeletal OA genu, plantar fasciitisGangguan proprioseptif

LAIN-LAIN :DehidrasiTIA, stroke akutParkinsonism, Penyakit Parkinson, hidrosefalus tekanan normal gangg gaya berjalanGangg serebelum, tumor intrakranial, SDH ketidakstabilan cenderung mudah jatuhDeconditioning effect keadaan reseptor saraf propioseptif yang terkondisi pasien pada keadaan berbaring saat duduk atau berdiri, sensasi perubahan lambat pusing, kepala berat, mau jatuhIntrinsic Factor : BalancePosture orientation of any body segment relative to thegravitational vector.Balance a term to describe the dynamics of body posture to preventfalling.

Balance requires keeping the Center of Mass (COM) over the Base of Support (BOS) during static and dynamic situations.http://www.pt.ntu.edu.tw/hmchai/bm03/BMClinic/Stance.htm#stabilityhttp://www.geriatria.unimo.it

Aging Effects on Postural Control

Buku Ajar Ilmu Penyakit Dalam.12Intrinsic Factor : OthersPostural hypotensionSBP drop 20%. Caused by dehydration, medication-related, autonomic disturbance.Medication> 4 drug / day is a risk factor.Anticonvulsant, sedative/hypnotic, antidepressant, neuroleptic, digoxin, diuretic, antiarrhytmic.Hazzards Geriatric Medicine . 6th ed.FAKTOR EKSTRINSIKFaktor-faktor yang berada di lingkungan yang memudahkan usila mengalami jatuhSebagian besar jatuh terjadi pada aktifitas ringan, dan di dalam rumahFaktor-faktor :Lampu kurang terang, lantai licin atau bertingkat, tangga, kloset dan bak mandi, karpet, kain panjang, tali sepatu, mainan anak-anakPengaruh obat-obatan (dizziness, vertigo, hipotensi, hiponatremia): diuretik, antihipertensi sentral, sedatifExtrinsic FactorsEnvironmental hazardsincrease susceptibility to falls.Home safety.

Hazzards Geriatric Medicine . 6th ed.Precipitating Factors Acute illness, such as pneumonia or exacerbation of congestive heart failure, may present as a fall in a frail older person because of altered mental status, postural hypotension , or weakness.

Risk of fall during first 2 weeks after discharge ~ 4x higher.

Hazzards Geriatric Medicine . 6th ed.Precipitating Factors

ABC of Geriatric Medicine.

Am Fam Physician.2000Apr1;61(7):2159-2168Evaluation of Falls

Buku Ajar Ilmu Penyakit Dalam.Evaluation of FallsBuku Ajar Ilmu Penyakit Dalam.

Evaluation of Falls

Evaluation of Falls

Evaluation of FallsPerformance Oriented Mobility Assessment (POMA) / Tineti assessment tool :Score ) & ekstrinsikPerlu pemeriksaan sensorik, motorik, koordinasiPrevensi terjadi jatuh lebih penting & utama daripada kurativ

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