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Seminario Caídas en el anciano
 

Seminario Caídas en el anciano

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  • the patient never mentions the event to a health care provider; there is no injury at the time of the fall; the provider fails to ask the patient about a history of falls; or either provider or patient erroneously believes that falls are an inevitable part of the aging process. Often, treatment of injuries resulting from a fall does not include investigation of the cause of the fall.
  • The incidence of falls increases with age and varies according to living status. Between 30 and 40 percent of community-dwelling people over the age of 65 years fall each year [ 3-8 ], increasing to about 50 percent for those 80 years and older [ 9,10 ]. In a US survey of over 90,000 people aged >65, falls were reported in the prior three months by 16 percent [ 11 ]. Falls were equally common between men and women, but were more likely to result in injury in women. The majority of nonfatal injuries in adults aged 65 and older who were treated in emergency departments in the US in 2001 were caused by falls [ 12 ]. Approximately 50 percent of individuals in the long-term care setting fall yearly [ 3,4 ]. Almost 60 percent of those with a history of a fall in the previous year will have a subsequent fall [ 5 ].

Seminario Caídas en el anciano Seminario Caídas en el anciano Presentation Transcript

  • Caídas Sandra Milena Acevedo RuedaMD Residente Medicina Interna UNAB Enero de 2013 Page 1
  • Clin Geriatr Med 29 (2013) 137–150 Page 2
  • Caídas El individuo cae usualmente Son comunes y son los ocurren cuando principales factores quelas deficiencias en varios dominios amenazan su ponen en peligro la capacidad de independencia compensación del individuo JAMA. 1995;273(17):1348. Page 3
  • Falta de atención clínica… JAMA. 1995;273(17):1348. Page 4
  • “80 percent of older women “80 percent of older womenpreferred death to a "bad" hippreferred death to a "bad" hip fracture fracture that would result in that would result in nursing home admission” nursing home admission” BMJ. 2000;320(7231):341 Page 5
  • Epidemiología 12.6 billones de dolares (1995)30 – 40% > 65 años (comunidad) se caen cada año (50% para mayores de 80ª)En una encuesta de EE.UU. de más de 90.000 personas > 65 años, las caídas se registraron en los tres meses anteriores en un 16% N Engl J Med. 2003;348(1):42 Page 6
  • EpidemiologíaEstudio en mujeres mayores de 70 a (2 años) 41 % trauma menor 6% trauma mayorPacientes institucionalizados tienen más trauma mayor 5% serán hospitalizados N Engl J Med. 2003;348(1):42 Page 7
  • “In an Australian study, 9.5 percent “In an Australian study, 9.5 percent of patients hospitalized for falls of patients hospitalized for falls became first-time residents of a became first-time residents of along-term care facility at discharge” long-term care facility at discharge” Emerg Med J. 2012 Sep;29(9):742-7. Page 8
  • Page 9
  • “ In a large study of elderly persons“ In a large study of elderly personsseeking emergency care after a fall,seeking emergency care after a fall,2.2 percent of injurious falls resulted2.2 percent of injurious falls resulted in death” in death” Am J Epidemiol. 1990;131(6):1028 Page 10
  • Miedo a caer Después de una caída… 60% restricción moderada 15% restricción marcada50% después de una fx de cadera J Am Geriatr Soc. 2010;58(9):1739 Page 11
  • Page 12
  • Clin Geriatr Med 29 (2013) 137–150 Page 13
  • Órganos de los sentidos Lentes multifocales aumentan el riesgoAgudeza visual, percepción de profundidad, adaptación a la oscuridad Propiocepción alterada Sistema vestibular alterado J Am Geriatr Soc. 2002;50(11):1760 Page 14
  • Page 15
  • Activación y composición muscular Activación muscular proximalMayor activación de músculos antagónicos Recuperación alterada Infiltración grasa y riesgo de Fx cadera J Am Geriatr Soc. 2002;50(11):1760 Page 16
  • Historia de caídas Riesgo de segunda Fx de cadera “Framingham Study”: 14.8%tuvieron una segunda fractura en los siguientes 4 años J Am Geriatr Soc. 2002;50(11):1760 Page 17
  • Page 18
  • Presión arterial Hipotensión ortostáticaMenos % agua, diuréticos, climas cálidos J Am Geriatr Soc. 2002;50(11):1760 Page 19
  • Enfermedades crónicas Enfermedad de Parkinson Dolor musculo-esquelético crónico Osteoartritis Diabetes J Am Geriatr Soc. 2002;50(11):1760 Page 20
  • Deterioro cognitivo “ In one study of 1600 persons aged 75 years and “ In one study of 1600 persons aged 75 years andabove, the risk of hip fracture over six year follow-upabove, the risk of hip fracture over six year follow-up was twice as high when the score on the mini- was twice as high when the score on the mini- mental status examination was suggestive of mild mental status examination was suggestive of mild impairment (score 18 to 23) compared with those impairment (score 18 to 23) compared with those with no impairment” with no impairment” J Am Geriatr Soc. 2002;50(11):1760 Page 21
  • Medicamentos “ In a meta-analysis of 22 studies involving multiple “ In a meta-analysis of 22 studies involving multipleclasses of drugs, the likelihood of falling was increased classes of drugs, the likelihood of falling was increasedwith the use of sedatives and hypnotics (odds ratio [OR]with the use of sedatives and hypnotics (odds ratio [OR]1.47, 95% credible interval (CrI) 1.35-1.62), neuroleptics 1.47, 95% credible interval (CrI) 1.35-1.62), neuroleptics and antipsychotics (OR 1.59, 95% CrI 1.37-1.83), and antipsychotics (OR 1.59, 95% CrI 1.37-1.83), antidepressants (OR 1.68, 95% CrI 1.47-1.91), and antidepressants (OR 1.68, 95% CrI 1.47-1.91), and benzodiazepines (OR 1.57, 95% CrI 1.43-1.72)” benzodiazepines (OR 1.57, 95% CrI 1.43-1.72)” Arch Intern Med. 2009;169(21):1952 Page 22
  • Alcohol, calzado, factores medio-ambientalesA mayor consumo de alcohol, mayor riesgo Suelas, tacones Ayudas especiales Pacientes institucionalizados J Am Geriatr Soc. 2002;50(11):1760 Page 23
  • Reportar caídas recurrentesReportar alteración en la marcha o el balance Buscar atención médica ó presentarse aldepartamento de urgencias cuando haya una caída Page 24
  • Historia clínica completa, valoración funcional y cognitiva Función musculo-esquelética Examen físico Laboratorios e imágenes Page 25
  • Short Physical Performance Battery (SPPB) 1. Repeated Chair Stands 2. Balance Testing a. Semitandem Stand b. Side-by-Side stand c. Tandem Stand 3. 8’ Walk (2.44 meters) Page 26
  • The "Get up and go" test for gait The "Get up and go" test for gait assessment in elderly patients assessment in elderly patientsFleming KC, Evand JM, Weber DC, Chutka DS. Practical Functional Assessment of Elderly Persons: A Primary-Care Approach [Symposium on Geriatrics-Part III]. Mayo Clinic Proceedings 1995; 70:890. Copyright © 1995 Mayo Foundation. Page 27
  • Page 28
  • Tinetti Performance Oriented Mobility Tinetti Performance Oriented MobilityAssessment (POMA)* Assessment (POMA)* Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. JAGS 1986; 34: 119-126. (Scoring description: PT Page 29 Bulletin Feb. 10, 1993)
  • BalanceTinetti TinettiPerformance PerformanceOriented OrientedMobility MobilityAssessment Assessment(POMA) (POMA) Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. JAGS 1986; 34: 119-126. (Scoring description: PT Page 30 Bulletin Feb. 10, 1993)
  • MarchaTinetti TinettiPerformance PerformanceOriented OrientedMobility MobilityAssessment Assessment(POMA) (POMA) Tinetti ME. Performance-oriented assessment of mobility problems in elderly patients. JAGS 1986; 34: 119-126. (Scoring description: PT Page 31 Bulletin Feb. 10, 1993)
  • Diagram offunctional reachtest to assessbalance inelderly persons Fleming KC, Evand JM, Weber DC, Chutka DS. Practical Functional Assessment of Elderly Persons: A Primary-Care Approach [Symposium on Geriatrics-Part III]. Mayo Clinic Proceedings 1995; 70:890. Copyright © 1995 Mayo Foundation. Page 32
  • Page 33N Engl J Med. 2003;348(1):42
  • The Prevention of Falls in Older Persons: Clinical Practice Guideline(http://www.medcats.com/FALLS/frameset.htm) from the American Geriatrics Society. For more information visit the AGS online at www.americangeriatrics.org. Page 34
  • The Prevention of Falls in Older Persons: Clinical Practice Guideline(http://www.medcats.com/FALLS/frameset.htm) from the American Geriatrics Society. For more information visit the AGS online at www.americangeriatrics.org. Page 35
  • N Engl J Med. 2003;348(1):42 Page 36
  • Ejercicio • Marcha y balance • Fuerza • Flexibilidad• Movimientos (TaiChi o baile) • Actividad física general • Resistencia Page 37
  • Medicamentos• Modificación de dosis y fármacos • Vitamina D • Evitar toxicidad Page 38
  • Otras intervencionesHipersensibilidad seno carotídeo y marcapasos (RaR 0.42, 95% CI 0.23-0.75) Cataratas (RaR 0.66, 0.45-0.95) Suplemento nutricional Hipotensión ortostática: medias elásticas, líquidos, fludrocortisona, Intervención en podiatría Protectores de cadera Caminador ó bastón Page 39
  • Tiempo en el suelo ““ A study of 1100 individuals over age 72 A study of 1100 individuals over age 72 found that 47 percent of the 313 who found that 47 percent of the 313 whoexperienced non-injurious falls were unableexperienced non-injurious falls were unable to get up for at least one hour after falling” to get up for at least one hour after falling” JAMA. 1993;269(1):65 Page 40
  • Anticoagulación ““ A decision analysis has concluded that a A decision analysis has concluded that a predisposition to falls, with potential head predisposition to falls, with potential headtrauma, is rarely a contraindication to the use trauma, is rarely a contraindication to the use of anticoagulants in older adult patients with of anticoagulants in older adult patients with atrial fibrillation (AF)” atrial fibrillation (AF)” Page 41
  • Medio ambiente Page 42
  • Recommended Components of Clinical Assessment and Management for Older Persons Living in the Community Who Are at Risk for Falling N Engl J Med. 2003;348(1):42 Page 43
  • Recommended Components of Clinical Assessment and Management for Older Persons Living in the Community Who Are at Risk for Falling N Engl J Med. 2003;348(1):42 Page 44
  • Guau! Gracias! Page 45