Yaşlı popülasyonda düşmeye yaklaşım

Düşme yaşlılarda sık karşılaşılan, ölüm ve hastalık oranlarında önemli miktarda artışa yol açan geriatrik sendromlardan biridir. Yaşlıda bilişsel, davranışsal ve yürütücü fonksiyonlarda gerileme ortaya çıktığında, düşme görülmeye başlanır. 65 yaş üstünde, sağlıklı ve toplum içinde yaşayanlarda kişi başı yıllık düşme oranı %30-40 iken, uzun dönem bakım merkezlerinde yaşayanlarda %50’lere çıkmaktadır. Önemli yaralanma olarak nitelendirebileceğimiz kırık (kalça, kol, bilek, pelvis), kafa ve ciddi yumuşak doku yaralanmaları, düşen yaşlıların %10-25’inde gelişebilmektedir. Düşme, çeşitli nedenlerden dolayı, klinik muayenede sıklıkla gözden kaçmaktadır: düşme sonrası yaralanma gelişmemişse hasta, doktora düşmeyi söylemeyebilir; doktor düşmeyi hastaya sormayabilir veya doktor ve hastanın yanlış düşüncesine göre düşme, yaşlanmanın bir parçası olarak değerlendirilebilir. Yaşlılar genellikle düşme konusunda kendiliğinden bilgi vermedikleri için hepsine yılda en az bir defa düşüp düşmediği sorulmalı, denge ve yürüme problemleri açısından değerlendirilmelidirler. Yaşlıda düşmenin birçok farklı nedeni vardır. Postüral dengeyi sağlayan vestibüler sistemde, yürüme ve kardiovasküler fonksiyonda, altta yatan yaş nedenli bozulmalara ilave bir faktör, normal denge mekanizmasını etkileyerek düşmeler gerçekleşebilir. Bu faktör bir akut hastalık (ateş, sıvı kaybı, aritmi vb.), yeni bir ilaç veya güvenli olmayan yürüme alanı olabilir. Yaşlı kişiler, ortaya çıkan ek streslerle başa çıkamayabilirler. Düşmeyi önleme ve sıklığını azaltmada, tıbbi girişimler, çevresel düzenlemeler, eğitim-egzersiz programları ve yardımcı aletler kullanılmaktadır. Risk faktörlerinin tespiti ve bunlara dikkat edilmesi veya ortadan kaldırılması, düşme oranını azaltabilmektedir. Bu nedenle, yaşlının hareketinin kısıtlanmasına, bakımevine yerleştirilmesine yol açan ve bağımsız yaşamını tehdit eden düşmenin değerlendirilmesi önem arz etmektedir.

Approach to fall in elderly population

Falls are one of the geriatric syndromes which occur commonly and significantly increase morbidity and mortality rates in elderly. The incidence of falls increases with age. Falls usually occur when impairments in cognitive, behavioral, and executive function begin. The incidence of fall is between 30 and 40 percent of community-dwelling people and approximately 50 percent of individuals in the long-term care setting over the age of 65 years. Fracture (hip, arm, wrist, pelvis), head trauma or major lacerations, as defined serious wounding, occur 10-25% of elderly cases. Fall is overlooked in clinical examination due to various reasons; the patient never mentions the event to a doctor; there is no injury at the time of the fall; the doctor fails to ask the patient about a history of falls; or either doctor or patient erroneously believes that falls are an inevitable part of the aging process. Elderly give not usually any self-information about fall, for this reason, all older patients should be asked at least once per year about falls and should be assessed in terms of balance and gait disorders. There are many distinct causes for falls in old people. Falls in older individuals occur when a threat to the normal homeostatic mechanisms that maintain postural stability is superimposed on underlying age-related declines in balance, ambulation, and cardiovascular function. This factor may be an acute illness (eg, fever, water loss, arrhythmia), a new medication, an environmental stress (eg, unfamiliar surrounding), or an unsafe walking surface. The elderly person can not cope with happened additional stress. To prevent and decrease the frequency of falls, effective approaches are medical interventions, environmental modifications, education-exercise programs, and assisted device. Detection and amelioration of risk factors can significantly reduce the rate of future falls. The assessment of fall, causing mobility restriction, use of nursing home, and treating independent live in elderly, are very important. and needs further studies.

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