fall in old age
Introduction
Introduction to old age falls A fall is a sudden accidental fall to the ground. Fall can occur at any age, but older people are more likely to see women, and women are significantly higher than men (1.5:1 to 2:1) because older women have less activity and poor muscle strength. Factors such as impaired balance and impaired cognitive ability are more serious than those of older men. Falling can lead to serious consequences such as psychological trauma, fractures and soft tissue injuries, affecting the mental health of the elderly and increasing the burden on families and society. A very important topic in elderly clinical medicine. basic knowledge The proportion of illness: the incidence of falls in the elderly is about 45% Susceptible people: the elderly Mode of infection: non-infectious Complications: fracture
Cause
Old age fall cause
(1) Causes of the disease
There are many reasons for the fall. In the elderly who were hospitalized due to the fall, the internal cause accounted for 45%, the external cause accounted for 39%, and the unexplained case was 16%.
Intrinsic reason
The posture stability of the human body depends on the sensory organs, the nervous system and the skeletal muscle system function and coordination, and the functional damage of any one system can reduce the stability of the body and cause the fall to occur.
(1) Long-term risk factors:
1 gait abnormality: gait is a complex of coordinated movement, age-related changes in coordinated exercise and many pathological changes can cause gait abnormalities in the elderly, such as nervous system diseases (latcle state, dementia, Parkinson's disease, stroke) , normal pressure hydrocephalus, chronic dural hematoma, cerebellar ataxia, spinal cord disease and peripheral neuropathy, etc., mental factors (depression) and other factors (osteoarthritis, hypothyroidism, muscle weakness and drugs), etc. The abnormal gait of the elderly is one of the important reasons for the fall, which deserves clinical attention.
2 balance function decline: visual, auditory, tactile, vestibular function and proprioception are important factors to maintain the balance of the human body. Any factor that can affect the above functions can make the balance function fall and fall, visual acuity, dark Age-related changes such as adaptation, peripheral vision, contrast sensitivity and accommodation, and certain diseases (cataracts, macular degeneration and glaucoma) can cause visual abnormalities in the elderly, tripping over because of invisible obstacles, wearing pairs The elderly in the glasses are easy to look at the wrong ground and fall and fall, especially when going up and down the stairs. The vestibular function plays an important role in maintaining the stereotactic orientation when the body rests or the body accelerates, and controls the stability of vision during exercise. Some ageing Changes (otolith), drugs (aminoguanidines, loop diuretics, aspirin, quinidine and alcohol), head trauma, eye surgery and infections can cause the elderly to lose balance and fall. The proprioceptive system is associated with maintaining body position (especially when changing position and walking on uneven ground), peripheral nerve age-related changes or diseases (sugar Disease, vitamin B12 deficiency, etc. cause sensory dysfunction, making the elderly prone to fall, structural and functional damage of bones, joints, ligaments and muscles can reduce the stability of the human body. Cervical spondylosis can affect the spinal cord and vertebral artery, affecting posture The fall of the control, lumbar strain and degenerative changes, the spine's ability to re-adjust the lower limbs is reduced. The quadriceps are the key factors for the stability of the lower limbs. The Japanese often have squats, squats, quadriceps. More developed, the incidence of falls is also low, the degenerative changes of the hips, knees, and ankles of the lower limbs, resulting in a decrease in joint stability and fall, and the coordination function of ankle dorsiflexion and plantar flexion plays a role in correcting the body imbalance. Therefore, the weak old squat flexor weakness is also one of the causes of falls in the elderly. Foot diseases such as bone spurs, synovitis and toenail deformities may provide false lower extremity proprioceptive information, leading to lower limb muscle strength and muscle tone. Balance imbalance and induce a fall.
(2) Short-term risk factors: the elderly due to circulatory autonomic dysfunction and carotid artery, vertebral atherosclerosis, in the acute and chronic diseases, more likely to fall than young people, arrhythmia is caused by the elderly fall One of the common causes; sudden rapid or slow arrhythmias can cause falls by lowering cardiac output and cerebral perfusion, and mild to moderate heart failure in the elderly is asymptomatic at rest, while cardiac output during activity The amount can not meet the needs of the body, there are shortness of breath, palpitations, unstable standing and falling, all kinds of shock, low blood pressure can cause falls, orthostatic hypotension is one of the common causes of falls, which is characterized by blood pressure when standing upright Dizziness, ataxia and falls, symptoms disappear in the supine position, acute myocardial infarction can fall due to severe arrhythmia or hypotension, upper gastrointestinal bleeding falls due to acute blood loss and shock, various infections in the elderly Can fall down as a first symptom, therefore, falls are a non-specific symptom of many elderly acute diseases, drugs are causing the elderly to fall Another important reason for the fall, the barbiturate can cause the elderly to fall at night and the next morning, long-acting benzodiazepines (nitrazepam, etc.) cause damage by impairing mental motor function, long-acting hypoglycemic agents Causes hypoglycemia and induces falls, orthostatic hypotension is common in the elderly, many patients are well adapted, essentially asymptomatic, however, in the use of barbiturates, phenothiazines, benzodiazepines, Tricyclic antidepressants, antihypertensive drugs, etc., can easily induce dizziness and falls.
2. External causes
Due to the decline of various functions, the elderly cannot respond to the changes in environmental factors in a timely and adequate manner like young and middle-aged people. Therefore, environmental factors play a role in the fall of the elderly, and about one-third of the fallers Related factors, more than 70% of the falls occurred at home, about 10% occurred on the stairs, and the lower floor was more common than the upper floor.
(1) There are three types of common environmental risk factors:
1 The object collapses, the ground is smooth, the light is dim, and heavy objects are carried;
2 wear slippers or inappropriate shoes;
3 improper furnishings, high bed too low, too soft and other factors make the elderly difficult to use and cause falls.
(2) The risk of environmental factors depends on the following factors:
1 The degree of disability of the elderly, for the elderly who have difficulty in walking, the arched carpet becomes an important environmental risk factor, even for the most debilitated elderly (long trousers and shoes with different sizes) ) It is also prone to fall.
2 Whether there is any experience of environmental factors, this is an important aspect to determine the degree of danger. Old people who do not normally go up and down the stairs may become an important risk factor when going up and down the stairs (often the first or last steps of the stairs), and often The elderly in the stairs, this risk is relatively small, in fact, most of the falls occur in daily activities that are often experienced, relatively dangerous, such as standing, walking, dressing, going to bed, going to the toilet, Cooking, bathing, etc.; only a few falls occur in dangerous activities, such as climbing ladders, moving heavy objects, participating in competitive activities, etc.
(two) pathogenesis
A fall is a pathological posture in which a patient walks. It is also a complex exercise process. Maintaining normal gait depends on complete spinal cord reflex, erect, various postures, neck-vestibular reflex and good spatial orientation ability. Coordination between the system and the motor system, when the spinal cord, brainstem, vestibule, cerebellum and cerebral cortex lesions cause the above reflexes to be incompletely coordinated and when the muscle lesions cause a fall, but the bone deformities, bones, joints, muscles, Falles caused by blood vessels, skin and subcutaneous tissue, etc. In addition, alcoholism, psychological damage, sedatives, etc. can also cause falls.
Prevention
Old age fall prevention
It is necessary to pay sufficient attention to the fall of the elderly and should be based on prevention. The purpose of prevention is to minimize the risk of falls under the conditions of daily activities and autonomic functions of the elderly. Since many factors are related to the occurrence of falls, prevention Need to consider in many ways.
1. Increase physical exercise
How to increase the impact of physical activity on the aging rate has not been determined, but it plays an important role in preventing the fall of the elderly. The elderly with more activities are significantly less troubled by falls than the inactive. Most of the elderly are the first to change. Lowering, often falling on uneven roads, partly because of the age-related decline in limb coordination, and the reduction in pelvic movement is an important factor. When walking, the pelvis must laterally support the weight of the leg to make another Legs move forward, and if the legs move too slowly, falls may occur. Therefore, increasing hip activity and balancing gymnastics can help prevent falls. A healthy older person may fall into falls unconsciously - losing confidence - Reduce the activity - the vicious circle of falling again. The best way to prevent this danger is to adhere to physical exercise and spiritual encouragement. The practice of balancing gymnastics is as follows. Each gymnastics is repeated 10 times.
(1) Section 1
1 Stand with one leg first, then stand with the other leg, and support with your fingers;
2 repeat the above gymnastics, each leg standing time is from 1 to 10;
3 Repeat the above gymnastics, standing for each leg from 1 to 20.
(2) Section 2
1 Sit on the dining chair, turn left and then turn right;
2 repeat the above gymnastics, arm outreach;
3 Touch your left foot with your right hand, then touch your right foot with your left hand.
(3) In the third quarter, sit up and pick up objects from the ground, then put them back to the ground.
(4) Fourth quarter
1 Stand and slowly pick up the object from the table, put it on the chair, and then put it back on the table;
2 Repeat the above gymnastics, but this time it is to slowly put the object on the ground.
2. Maintain mental activity
Older people with more social activities have a lower incidence of falls than older people with less social activity, suggesting that maintaining strong mental activity can prevent falls, dementia and depression patients are less focused, less able to correct imbalances, and Causes of danger to the environment, etc., tend to fall easily, mobilize patients to participate in health classes and gymnastics and other activities, through the stimulation of these new activities, can improve the patient's attention and help prevent falls.
3. Treatment related diseases
Although it is difficult to prevent falls caused by acute diseases of the elderly (pneumonia, upper gastrointestinal bleeding, etc.), effective control of chronic diseases is an important measure to prevent falls. Hypertension has a detrimental effect on cerebellum and brain function, often in the presence of mutual aid. Long before the disorder or short gait, there is damage to the balance function, so effective treatment of senile hypertension, is conducive to the prevention of falls, many elderly people with reduced posture control and cerebellar and basal ganglia infarction, perfusion or degeneration Related, strengthening treatment in this area can reduce the incidence of falls.
4. Avoid using inappropriate drugs
Older people should be banned or used with caution in order to avoid drug-induced falls.
5. Improve environmental factors
In the nursing home, although there are more complete safety measures, the incidence of serious falls is still 11.7%, indicating that only the improvement of environmental factors to prevent falls has limited effect. In addition, for the elderly who love activities, environmental risk factors rarely cause falls. Therefore, it is inappropriate to overemphasize the role of environmental risk factors in the incidence of fall. Environmental risk factors are only an important cause of falls for elderly people with weak or inconvenient movements. Safety measures for improving nursing homes and families are still worthy of attention. The bathroom is close to the bedroom, the handrails and corridors should have handrails, the furniture should be placed properly, the height of the bed and chair should not be too low, the ground area should be prevented, the lighting should be increased, and appropriate shoes and pants should be worn to reduce the occurrence of falls.
Complication
Elderly fall complications Complications
Common complications include psychological trauma, fracture and soft tissue injury and even accidental death.
Symptom
Old age fall symptoms common symptoms orthodontic disorder weak sprain weakness bone brittle gait abnormality dizziness hearing loss osteoporosis palpitations
Physical injury
The rate of physical injury caused by falls is 10%, including 5% of severe soft tissue injuries, including joint blood, dislocation, sprain and hematoma. The fracture accounts for 5%, mainly the surgical neck of the humerus, the distal radius and hip fracture, due to the elderly Osteoporosis, increased bone fragility, fractures are prone to fall when falling, and rise sharply with age. According to statistics, the incidence of hip fractures in people aged 80-84 is 100 times that of 60-64 years old, and the consequences are severe. The mortality rate is 20% in the 3 months after the fracture. The cause of death is often a complication of lung infection caused by prolonged bed rest. Even if the difficulties are overcome, many patients will be disabled for life, and the overall mortality rate of the elderly falls over the elderly without falls. 5 times higher, if you can't stand up after 1 hour after falling, the mortality rate is 1 times higher. The number of people who died over 85 years old (147/100,000) is significantly higher than those under 65 (1.5/10). 10,000), statistics show that accidental injury caused by falls is the sixth cause of death in the elderly.
2. Mental injury
Although 90% of the elderly who fall are not causing physical damage, the fall brings great psychological trauma to the elderly. About 50% of the fallers are afraid of falling again. Because of this fear, the avoidance of the activists falls. 25%, therefore, the fear of falling can cause a fall - loss of confidence - do not dare to act - weak - more vicious cycle of falling, even bedridden, therefore, to fully understand the serious consequences of this psychological trauma.
1. Learn more about the situation at the time of the fall
(1) The body condition during the fall: the disease of the body, whether there is any worsening or complications in the near future, acute illness, medication, and normal activity, etc., whether there are aura symptoms before the attack (dizziness, dizziness, instability, palpitations, etc.) ), helpful for the diagnosis of the cause, such as dizziness when the patient is upright, and then fell to the ground, should consider orthostatic hypotension, muscle weakness or painful osteoarthrosis in the elderly must stand hard when standing, produce Valsalva effect, make the heart output The amount and amount of cerebral perfusion are reduced, and dizziness and falls can also occur. For example, patients with heart failure have no dizziness when standing up, and dizziness after a few meters. It may be that the patient's cardiac output cannot be increased correspondingly, and it is difficult to meet the needs of the body's activities. Inducing dizziness, it indicates vertebral artery insufficiency or carotid sinus sensitivity syndrome. The latter often causes bradycardia when the carotid sinus is lightly compressed. For example, dizziness is not related to standing and walking, and is accompanied by tinnitus and hearing loss. , pointing to the inner ear lesions; if accompanied by a transient focal neurological disorder, suggesting transient ischemic attack; if accompanied by palpitations should consider rapid or slow arrhythmia Before the onset, there is no dizziness and palpitations, and no objects fall down. You should think of brain, hip joint lesions (which can be painless), muscle weakness or posture imbalance. People who fall due to muscle weakness often cannot climb on their own. Waiting for assistance, alcohol consumption in depressed depression can increase the role of sedatives, make the body stand unstable and fall and fall, the original orientation disorder and mental disorders should consider the fall caused by dementia, so patients are dangerous to the environment The patient's ability to correct the imbalance is reduced and the concentration is not concentrated, causing the patient to fall.
(2) Activity during falls: falls occur in non-hazardous activities of daily life or in certain dangerous sports. The former can be prevented through balance and gait training and environmental improvement. The latter should be Avoid similar sports.
(3) Environmental factors in the fall: Whether the living environment has changed recently, whether it lives with children? Most falls occur at home, should understand the layout of the family, whether there are stairs or modern furniture, whether the lighting is sufficient, carpet Whether there is arching, whether the ground is non-slip, whether the shoes are suitable, and walking aids (crutches, belts), etc., a successful family visit can often identify the risk factors that the patient may not know but may cause repeated falls. .
2. Comprehensive physical examination
There are many reasons for falling, and there are many reasons for a patient. However, the symptoms of the elderly are mutually concealed and often difficult to identify. For example, elderly people without vestibular disorders may have dizziness, but those who have vestibular dysfunction. There is only dizziness, so every patient should be thoroughly examined regardless of their symptoms. General examination may be an important clue to the cause of the fall, such as cachexia, Parkinson's disease, hemiplegia, arthritis, multiple nutritional deficiencies, hyperthyroidism. Or low-grade diseases, check the injured part to estimate the frequency or severity of the fall, whether the head is injured, whether there is a disturbance of consciousness, whether the whole body condition is worse or not, etc. If the patient is more unstable after falling, consider the subdural hematoma. Possibility, balance and gait are the ultimate manifestations of body sensation, nervous system and musculoskeletal system function. Therefore, understanding balance and gait is a reliable method to evaluate the comprehensive function of the above system. Computer evaluation is difficult to popularize, but direct observation of patients Posture changes and walking movements in daily life are still a simple and reliable method.
(1) The performance of the balance function is as follows:
1 From the seat standing, the performance can not stand up at one time, help to prop up with your hands, the body moves to the front of the seat and then stands up or stands unstable;
2 sitting down from the chair appears to fall into the chair or can not sit in the center;
3 impedance ability (light push the chest 3 times) manifested as foot movement, grab support or foot swing;
4 when standing with a closed eye or turning around, the performance is the same as 3;
5 heel lifted up as dizziness, dizziness, can not pick up, body swing or grasping support;
6 Bends are not able to bend over and pick up objects. After many attempts to stand up or grab the object to stand up, etc., then let the patient walk and walk, and do some performances (such as standing on one foot, turning, bending Waist, constant speed and fast walking, etc.).
(2) The gait abnormalities are as follows:
1 starts to hesitate, squat or grab support;
The 2-step performance is such as walking or walking too high (>5.1cm);
3 poor continuity (discontinuous);
4 asymmetry (the length of the step is different, the disease side is longer);
5 steps are not straight or the side of the disease is swaying;
6 Turning performance is first set, squat, shaking or grabbing support, balance and gait analysis is helpful to guide treatment, such as the patient standing up from the chair, physical training of quadriceps and coordination during movement Sexuality, and the use of high-seat chairs with armrests increases the stability of the patient when standing up and prevents falls.
3. Determine the type and cause
After understanding the above information, first determine whether the patient is an accidental fall or a spontaneous fall. The former refers to the fall caused by environmental risk factors, and the nature of vision and obstacles should be understood. The latter refers to the disease or drug. Falling is mainly seen in systemic diseases such as sensation, nerves, musculoskeletal, cardiovascular, etc., and then the specific causes of each type are determined.
Examine
Old age fall check
The white blood cell count in elderly fracture patients can be normal or elevated.
The patient fell accidentally with an abnormality, X-ray or CT was abnormal, and the electrocardiogram of the heart disease was abnormal.
Diagnosis
Elderly fall diagnosis
Old age falls should be differentiated from snoring.
