Acil Servise Başvuran Yaşlı ve İleri Yaşlılarda Düşme Risk Faktörlerinin Karşılaştırılması

Amaç: Düşmeler, basit bir yaralanmadan hayatı tehdit eden durumlara kadar geniş bir yelpazede sonuçlara neden olabilir. Düşmeler yaşlı yetişkinlerde önemli bir mortalite ve morbidite nedeni olduğundan, risk faktör-lerinin belirlenmesi önemlidir. Amacımız acil servise düşme ile başvuran geriatrik hastalarda düşme risk fak-törlerini değerlendirmek ve 85 yaş altı ve üstü grupta düşme risk faktörlerinin değişkenliğini değerlendirmektir. Materyal ve Metod: Bir üniversite hastanesi acil servisine düşme nedeniyle başvuran 132 geriatrik hasta geriye dönük olarak incelendi. Hastaların demografik özellikleri ve kronik hastalıkları, ilaç sayısı, düşme öyküsü, istemsiz kilo kaybı, depresif semptomlar, anemi, düşme korkusu, ortostatik hipotansiyon varlığı kaydedildi. Ed-monton kırılganlık ölçeği, saat çizme testi ve geriatrik depresyon ölçeği skorları da değerlendirildi. Bulgular: Çalışma popülasyonumuzun yaş ortalaması 80.5 ±8.3 idi. Hastaların 80'i (%60,6) 85 yaş altında iken, 52'si (%39,4) 85 yaş ve üzerindeydi. Hastaların 62'si (%47) kırılgandı, 10’unda (%7.6) ortostatik hipotansiyon vardı. Düşme korkusu 67 (%50,8) hastada gözlenmiştir. 62 (%47) hastada polifarmasi mevcuttu. Diabetes melli-tus sıklığı, kırılganlık, düşme korkusu, yürümeye yardımcı cihaz kullanımı ve düzenli bakıcı ihtiyacı 85 yaş üstü grupta anlamlı olarak daha yüksek, saat çizme test skoru daha düşüktü (hepsi için p<0.05. Sonuç: Yaşlı hastalarda düşmeler yaygındır. Çalışmamız acil servise düşme ile başvuran yaşlılarda düşme risk faktörlerinin sıklığını açıkça ortaya koymuştur. Düşme ile başvuran ileri yaş hastalarda (85 yaş üzeri) kırılganlık sıklığı daha yüksek olup, bu hastalarda daha önce düşme öyküsü olmasa bile düşme korkusu saptanmıştır. Düşmelerin olumsuz sonuçları göz önünde bulundurularak gerekli önlemler alınmalıdır.

Anahtar Kelimeler:

fall, geriatric, emergency department, risk factor

Comparison of Risk Factors for Falls in the Old and the Oldest Old Admitted to the Emergency Department

Background: Falls can cause a wide range of consequences from a simple injury to life-threatening situations. As falls are a major cause of mortality and morbidity in older adults, it is important to identify risk factors. Our aim was to evaluate fall risk factors in geriatric patients presenting to the emergency department with fall and to evaluate the variability of fall risk factors in the group below and above 85 years of age (oldest old). Materials and Methods: A total of 132 geriatric patients admitted to the emergency department of a univer-sity hospital due to falls were retrospectively analysed. Demographic characteristics and chronic diseases of patients, number of drugs, previous fall history, unintentional weight loss, depressive symptoms, anaemia, urinary incontinence, fear of falling, orthostatic hypotension were recorded. Edmonton frail scale, clock-draw-ing test and geriatric depression scale score was also evaluated. Results: The mean age of our study population was 80.5 ±8.3. While 80 (60.6%) of the patients were below 85 years of age, 52 (39.4%) were aged 85 years and older. 62 (47%) of the patients were frail and orthostatic hypotension was found in 10 (7.6%) of the patients. Fear of falling was observed in 67 (50.8%) patients. Polypharmacy was present in 62 (47%) patients. Frequency of diabetes mellitus, frailty, fear of falling, walking aid usage and the need for a regular caregiver were significantly higher and clock-drawing test score was lower in the oldest old group (p<0.05, for all). Conclusions: Falls are common in older patients. Our study clearly revealed the frequency of fall risk factors in the geriatric population admitted to the emergency department. The frequency of frailty was higher in the oldest old (over 85 years old) who presented with falls, and fear of falling was found in these patients even if there was no previous history of falling. Necessary precautions should be taken considering the negative con-sequences of falls.

Keywords:

Fall Geriatric, Emergency department, Risk factor, Oldest old,

PDF

___

1. Montero-Odasso M, van der Velde N, Martin FC, Petrovic M, Tan MP, Ryg J, et al; Task Force on Global Guidelines for Falls in Older Adults. World guidelines for falls prevention and ma-nagement for older adults: a global initiative. Age Ageing. 2022 Sep 2;51(9):afac205. doi: 10.1093/ageing/afac205.
2. Milat AJ, Watson WL, Monger C, Barr M, Giffin M, Reid M. Prevalence, circumstances and consequences of falls among community-dwelling older people: results of the 2009 NSW Falls Prevention Baseline Survey. N S W Public Health Bull. 2011 Jun;22(3-4):43-8. doi: 10.1071/NB10065.).
3. Ambrose AF, Paul G, Hausdorff JM. Risk factors for falls among older adults: a review of the literature. Maturitas. 2013 May;75(1):51-61. doi: 10.1016/j.maturitas.2013.02.009.
4. Moreland B, Kakara R, Henry A. Trends in Nonfatal Falls and Fall-Related Injuries Among Adults Aged ≥65 Years - United States, 2012-2018. MMWR Morb Mortal Wkly Rep. 2020 Jul 10;69(27):875-881. doi: 10.15585/mmwr.mm6927a5
5. Suzan V, Kanat BB, Yavuzer H. Fatigue and primary sarcopenia in geriatric patients. Rev Assoc Med Bras (1992). 2022 Nov 14;68(11):1565-1570. doi: 10.1590/1806-9282.20220662.
6. Cuevas-Trisan R. Balance Problems and Fall Risks in the El-derly. Clin Geriatr Med. 2019 May;35(2):173-183. doi: 10.1016/j.cger.2019.01.008.
7. Perna S, Francis MD, Bologna C, Moncaglieri F, Riva A, Moraz-zoni P, Allegrini P, Isu A, Vigo B, Guerriero F, Rondanelli M. Performance of Edmonton Frail Scale on frailty assessment: its association with multi-dimensional geriatric conditions asses-sed with specific screening tools. BMC Geriatr. 2017 Jan 4;17(1):2. doi: 10.1186/s12877-016-0382-3.
8. Fedorowski A, Ricci F, Hamrefors V, Sandau KE, Hwan Chung T, Muldowney JAS, Gopinathannair R, Olshansky B. Orthostatic Hypotension: Management of a Complex, But Common, Me-dical Problem. Circ Arrhythm Electrophysiol. 2022 Mar;15(3):e010573. doi: 10.1161/CIRCEP.121.010573.
9. Hooper L, Abdelhamid A, Attreed NJ, Campbell WW, Channell AM, Chassagne P, Culp KR, Fletcher SJ, Fortes MB, Fuller N, Gaspar PM, Gilbert DJ, Heathcote AC, Kafri MW, Kajii F, Lind-ner G, Mack GW, Mentes JC, Merlani P, Needham RA, Olde Rikkert MG, Perren A, Powers J, Ranson SC, Ritz P, Rowat AM, Sjöstrand F, Smith AC, Stookey JJ, Stotts NA, Thomas DR, Vi-vanti A, Wakefield BJ, Waldréus N, Walsh NP, Ward S, Potter JF, Hunter P. Clinical symptoms, signs and tests for identifica-tion of impending and current water-loss dehydration in older people. Cochrane Database Syst Rev. 2015 Apr 30;2015(4):CD009647. doi: 10.1002/14651858.CD009647.pub2.
10. Verghese J, Wang C, Xue X, Holtzer R. Self-reported difficulty in climbing up or down stairs in nondisabled elderly. Arch Phys Med Rehabil. 2008 Jan;89(1):100-4. doi: 10.1016/j.apmr.2007.08.129
11. van der Burg M, Bouwen A, Stessens J, Ylieff M, Fontaine O, de Lepeleire J, Buntinx F. Scoring clock tests for dementia screening: a comparison of two scoring methods. Int J Geriatr Psychiatry. 2004 Jul;19(7):685-9. doi: 10.1002/gps.1143.
12. Ulugerger Avci G, Suzan V, Bektan Kanat B, Unal D, Emiroglu Gedik T, Doventas A, Suna Erdincler D, Yavuzer H. Depressive symptoms are associated with sarcopenia and malnutrition in older adults. Psychogeriatrics. 2023 Jan;23(1):63-70. doi: 10.1111/psyg.12903.
13. Cederholm T, Jensen GL, Correia MITD, et al. GLIM criteria for the diagnosis of malnutrition - A consensus report from the global clinical nutrition community. Clin Nutr. 2019;38(1):1-9. doi:10.1016/j.clnu.2018.08.002
14. Wu JX, Deng FY, Lei SF. The Casual Association Inference for the Chain of Falls Risk Factors-Falls-Falls Outcomes: A Mende-lian Randomization Study. Healthcare (Basel). 2023 Jun 29;11(13):1889. doi: 10.3390/healthcare11131889.
15. Crews JE; DPA; Chou CF, Stevens JA, Saaddine JB. Falls Among Persons Aged ≥65 Years With and Without Severe Vision Im-pairment - United States, 2014. MMWR Morb Mortal Wkly Rep. 2016 May 6;65(17):433-7. doi: 10.15585/mmwr.mm6517a2.
16. Hausdorff JM, Herman T, Baltadjieva R, Gurevich T, Giladi N. Balance and gait in older adults with systemic hypertension. Am J Cardiol. 2003 Mar 1;91(5):643-5. doi: 10.1016/s0002-9149(02)03332-5.
17. Altmann CF, Koschel J, Jost WH. Predictors of falls in Parkin-son's disease, progressive supranuclear palsy, and multiple system atrophy: a retrospective study. Neurol Neurochir Pol. 2023;57(3):297-304. doi: 10.5603/PJNNS.a2023.0036.
18. Savas S, Yenal S, Akcicek F. factors related to falls and the fear of falling among elderly patients admitted to the emergency department. Turkish Journal of Geriatrics 2019;22 (4):464-473. doi: 10.31086/tjgeri.2020.125.
19. Escourrou E, Durrieu F, Chicoulaa B, Dupouy J, Oustric S, And-rieu S, Gardette V. Cognitive, functional, physical, and nutriti-onal status of the oldest old encountered in primary care: a systematic review. BMC Fam Pract. 2020 Mar 27;21(1):58. doi: 10.1186/s12875-020-01128-7.