RISK FALL N ELDERLY

JULI DWI PRASETYONO

 Lansia :Populasi Berisiko

Lansia sebagai Teori

populasi berisko Konsekuensi
(Stanhope & fungsional
Lancaster, 2012) (Miller, 2012)

Risiko Biologi, lingkungan &

konsekuensi (-)
perilaku
Penurunan Fungsi
muskuloskeletal
Penurunan
QOL Risiko jatuh Penurunan
keseimbangan tubuh
 Fear of Falling

Activity restriction Poor perceived health

Social withdrawal Reduced strength

Poor balance

Increased disability Increased fall risk

Reduced independence

Poor quality of life

Epidemiology of falls in elderly

• Definitions

• Classifications
Ageing

• Incidence
 Epidemiology of falls in elderly
Classifications:

• Falls  Fallers
 Non-fallers
Intrinsic
 Trigger
 Once-only fallers
Extrinsic
 Recurrent fallers
 Consequence Injurious

Non-injurious
Epidemiology of falls in elderly
Incidence:
• Accidents are the 5th leading cause of death in older
adults 1
• Falls account for 2/3 of these accidental deaths
• 1/3 of adults over 65 living in the community fall at
least once a year
• This rises to ½ of adults over age 80 2,3
• 5% of these falls result in a fracture or hospitalization
• Mobility abnormalities affect 20-40% of adults over 65
and 40-50% of adults over age 85 4,5
 Fall prevention
• The quality of falls care in older adults is
suboptimal
• If we can reduce the risk factors for falling,
then we can reduce the incidence and the
morbidity associated with falls
• 3 studies have found that 65-100% of older
adults with 3 or more risk factors fell in a 12
month period compared with 8-12% of older
adults without any risk factors 1,6-8
 Clinical Guidelines for Gait and
Balance
• Provide interventions to improve balance,
transfers and gait 19
• Do a gait and balance assessment for those
requiring medical attention because of a fall,
report recurrent falls in the past year or
demonstrate abnormalities of gait or balance
20

• Risk assessment includes assessment of gait,

balance, mobility and muscle weakness 21
 Screening and Examination of Gait
and Balance

• Timed Get Up and Go Test

• Single Leg Stand Test
• Dynamic Gait Index
• Berg Balance Scale
Homes Are Not Typically Designed For
Users of Various Abilities
Life Span Development Aging-in-Place

Acute Injury Chronic Disability

 Difficulty Moving Around at Home
• Hard to go up stairs 35%
• Difficulty walking 15%
• Use of cane/walker 8%
• Use of wheelchair/scooter 6%
• Difficulty bathing 3%
• Chair or bed transfers 3%

(Source: Fixing to Stay, 2002)

 Important Housing Features
• Main floor, bath
• Main floor, bedroom
• Accessible climate controls
• Non-slip flooring
• Bathroom aids
• No step entrance
• Covered parking

(Source: These Four Walls…, May 2003)

 Occupational Therapy considers the
physical context
• During Assessment
– Understand obstacles/barrier to participation
– Understand supports to participation
– Consider individual, groups, populations who use the physical space

During intervention
Reduce activity demands from the environment
Insure adequate supports
Facilitate performance though the use of the environment
Avoid further functional decline and excess disability caused by environmental
factors
 3 Major Problem Areas
of the Home:

• Outside Steps To The Entrance

• Inside Stairs To A Second Floor

Source: HUD (2001)
 Other Alternatives to Entrance with
Outside Steps

• Ramps
• Earth Berms/Walkways
• Lifts
• Zero Step entrance
Other Strategies for Getting Upstairs

• Chair lift
• Elevator
• Relocate rooms to
main floor
 Strategies for Bathing

• Bath bench/chair
• Bath lift
• Grab bars
• Visual contrast
• Non slip surface
• Hand held showerhead
• Shower/wet room
• Curbless shower
 Checklists--Examples

• Home Safety Council

www.homesafetycouncil.org/resource_center/rc_checklist_w001.aspxp
• Rebuilding Together --Checklist
www.rebuildingtogether.org

• CDC Check for Safety

www.cdc.gov/ncipc/pub-res/toolkit/checkforsafety.htm
http://www.cdc.gov/ncipc/falls/FallPrev4.pdf
http://www.cdc.gov/ncipc/duip/fallsmaterial.htm
 Masalah keseimbangan & pencegahnnya
 Tai-Chi (Hiyamizu et al, 2011
Pencegahan jatuh karena  Stay Safe-Stay active (CDC, 2010)
gangguan keseimbangan  Otago exercise (CDC, 2010)
yang dilakukan selama ini:  Latihan keseimbangan (Maryam, 2009)

 Prosedur Latihan yang membutuhkan

waktu yang lama
 Gerakannya sulit
 Efek terhadap jatuh belum sempurna
Apa yang belum
 Belum melihat efek latihan terhadap 4
variabel sekaligus
maksimal?

 Memadukan antara pemanasan,

keseimbangan, kekuatan, fleksibilitas &
pendinginan
LKS Lansia  Waktu latihannya singkat
 Peralatannya sederhana
 Gerakannya sederhana
 Dapat menjadi intervensi pilihan di
komunitas