UNIT 4: COMMON DISORDERS IN THE AGING 4.5 GERIATRIC SYNDROMES: FALLS AND INESTABILITY

The elderly has an increased risk of falling. Specifically, 20% of population over age 65 have some type of limitation in activities of daily living to facilitate falls (Cuesta-Triana F, 2001). In most cases occurs at home environment and many of these are produced by an inaccurate adjustment of the home environment.



The fall is multifactorial in origin, relevant in the elderly and may be a manifestation of disease. A fall can generate functional dependency, creating a vicious cycle, and which in turn relates to more falls (Tinetti ME, 2010). It can lead to a loss of independence in the elderly, generating a high health spending. This risk will result in the patient immobility, can worse the medical history or even the appearance of new diseases that may worsen the picture, and even the elderly can die.

It is therefore essential the fall risk assessment and all elderly person must be evaluated considering factors for falls risk presented (Scott V, 2007)

From the nurse’s point of view there are necessary implement security strategies in the elderly to reduce the incidence of falls and their complications. This requires identifying the population at risk and implement nursing interventions that are effective for the prevention of falls.
First it is important to identify the risk factors. It has been identified about 400 risk factors. The most common are:
- Weakness (sarcopenia)
- Gait disturbance
- Limitation of mobility
- Visual deficit
- Cognitive impairment
- Type 2 Diabetes Mellitus
- Sex female
- Functional dependence
- Drugs with sedative effect
- Orthostatic Hypotension
- Environmental factors: low visibility, bathrooms without bearing support, etc. (Masud T, 2001)

Downton Scale is useful for carrying out a risk assessment.

The first preventive measure is to inform patients and their caregivers about the existence of risk. From there work and collaborate in modifying home environments that can be dangerous, without compromising the functional independence of the elderly.
Usually, the patient with a fall, suffering a sharp process is revealed as a precipitating factor. Eg urinariom infection respiratory tract, anemia, angina, etc. (Kallin K, 2002).

After the fall, only 41% of elderly go to a medical service and more than half of them, have more than one fall per year.
To prevent a fall is necessary to know the risk factors, the characteristics of the fall and the patient's environment.
So when there is a fall, we must make appropriate records, performing a systematic assessment in the elderly, noting incidents, causes that led to the fall, and record the treatment and care that had to apply. Assess the factors related to the fall and notify relatives. And then make appropriate monitoring in the elderly for abnormalities produced as a result of the fall.

It is important to advise the elderly on existing measures and appropriate technical assistance to him, and informer the patient about economic aid that the health system provides.

REFERENCES :

• Treaty of geriatrics for residents. Spanish Society of Geriatrics and Gerontology. [Home Site] [accessed May 18, 2013] Available at: http://www.segg.es/tratadogeriatria/main.html

• Clinical Practice Guideline: Assessment Comprehensive Geriatric Gerontological Ambulatory Elderly. Mexico: Ministry of Health, 2011. Available at: http://sgm.issste.gob.mx/medica/medica_documentacion/guias_autorizadas/Geriatr%C3%ADa/IMSS-491-11-valoraci%C3%B3n%20geronto-geriatrica/IMSS-491-11-GER%20Valoraci%C3%B3n%20geronto%20geriatrica.pdf