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INSTABILITAS Dr. Suhaemi, SpPD, Finasim

In Stabilit As

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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