INSTABILITAS

Dr. Suhaemi, SpPD, Finasim

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

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

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
Neurologi : TIA, stroke, kejang dll
Idiopatik
Sinkope : Drop attack, penurunan darah ke otak
mendadak, terbakar matahari.

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

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

PENATALAKSANA
AN:
Pencegahan : - identifikasi dan eliminir f.risiko
-penilaian keseimbangan/gait
-mengatur/mengatasi f.situasi
Pendekatan diagnostik : assesment geriatri
Pengobatan

GAIT ABNORMALITIES AND FALLS

GAIT ABNORMALITIES AND FALLS

GAIT ABNORMALITIES AND

FALLS

FALLING: A GERIATRIC
SYNDROME
Geriatrics 11

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

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 12

COMPLICATIONS OF FALLS

COMPLICATIONS OF FALLS

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 13

(CONTD)

MEDICAL RISK FACTORS FOR FALLS

Geriatrics 14

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, Parkinsons, myelopathy,
cerebellar disorders

Intrinsic factors:
Changes

Geriatrics 15

TYPES OF FALLS:
INTRINSIC VS. EXTRINSIC

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

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 16

TYPES OF FALLS (CONTD)

Fractures with Hip Protectors

2.1%

But patient acceptance low

Kannus. NEJM;2000;343;1506-1513

UCSF Division of Geriatrics Primary

Care Lecture Series May 2001

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)

www.hipsavers.c
om

UCSF Division of Geriatrics Primary

Care Lecture Series May 2001

CDC FALL PREVENTION

RECOMMENDATIONS: THE 4 PEARLS

Regular exercise
Medication review
Vision exams
Home safety
evaluation

COMMON TYPES OF FRACTURES

Forearm (Wrist) Fracture
Spine Fracture
Hip Fracture (pelvis, hip, femur)
Ankle Fracture
Upper arm, forearms, hand

FRAGILE BONE

Osteoporosis, or brittle bones

Fall induced fractures

Normal
Normal Bone
Bone

Osteoporotic
Osteoporotic Bone
Bone

ASSISTANT DEVICES
Hip pads
Mobility aids

Cane

Walkers

Wheelchairs

Bathroom aids

Raised toilet seats

Grab bars