tailieunhanh - Ebook Essentials of clinical geriatrics (7/E): Part 2

Part 2 book “Essentials of clinical geriatrics” has contents: Falls, immobility , cardiovascular disorders, decreased vitality, sensory impairment, drug therapy, drug therapy, health services, ethical issues in the care of older persons, palliative care. | 229 Chapter 9 Falls AGING AND INSTABILITY Several age-related factors contribute to instability and falls (Table 9-2). Most “accidental” falls are caused by one or a combination of these factors interacting with environmental hazards. Aging changes in postural control and gait probably play a major role in many falls among older persons. Increasing age is associated with diminished proprioceptive input, slower righting reflexes, diminished strength of muscles important in maintaining posture, and increased postural sway. All these changes can contribute to falling—especially the ability to avoid a fall after encountering an environmental PART II Falls are a major cause of morbidity in the geriatric population. Close to onethird of those age 65 years and older living at home suffer a fall each year. Among nursing homes residents, as many as half suffer a fall each year; 10% to 25% cause serious injuries. Accidents are the fifth leading cause of death in persons older than age 65, and falls account for two-thirds of these accidental deaths. Of deaths from falls in the United States, more than 70% occur in the population older than age 65. Fear of falling can adversely affect older persons’ functional status and overall quality of life. Repeated falls and consequent injuries can be important factors in the decision to institutionalize an older person. Table 9-1 lists potential complications of falls. Fractures of the hip, femur, humerus, wrist, and ribs and painful soft tissue injuries are the most frequent physical complications. Many of these injuries will result in hospitalization, with the attendant risks of immobilization and iatrogenic illnesses (see Chapter 10). Fractures of the hip and lower extremities often lead to prolonged disability because of impaired mobility. A less common, but important, injury is subdural hematoma. Neurological symptoms and signs that develop days to weeks after a fall should prompt consideration of this treatable problem. Even