The problem of falls among the elderly: what are the main risk factors and the most effective preventive measures? Prevention of falls in the elderly and senile age.

FALL PREVENTION
IN OLD AND OLD AGE

Causes, principles of diagnosis and prevention of falls in elderly and senile people are given; main components of nursing care.

The WHO defines a fall as “an incident in which a person suddenly falls to the ground or
on another low surface, except as a result of a blow, loss of consciousness, sudden paralysis or an epileptic seizure. Falls are the second leading cause of death from accidents and unintentional injuries. Every year in the world
Falls cause 424,000 deaths, 80% of which occur in low- and middle-income countries. Greatest
the number of fatal falls with consequences serious enough to require medical attention are among people over 65 years of age (WHO).
At a young age, falls are often limited to bruises or abrasions, and in older people they are often accompanied by serious injuries.
and life-changing fractures, resulting in disability, immobility, and early, often painful, death. Fall injuries can be of a wide variety. The most dangerous, entailing complications, are craniocerebral injuries, femoral neck fractures, joint dislocations, spinal injuries, and soft tissue injuries. Why do healthy, active people rarely fall?

Firstly, due to the reflex regulation of movements, the correct operation
centers of balance and the vestibular apparatus, providing walking and balance. Secondly, thanks to good eyesight, which allows you to correctly navigate the environment and avoid obstacles. Elderly and old people fall frequently, in particular due to age-related changes in the musculoskeletal system. Prevalence of violations
walking and balance increases with age:

from 25% aged 70–74 years
up to 60% in the age group of 80–84 years.

You can see how after 60
gait changes slightly over the years, and after 75 years, a person, as a rule, walks slowly, swaying while walking. This is due to a decrease in stride length and the height to which the foot rises. In young people, the angle of elevation of the foot is 30º, and in older people it is only 10º. By old age, sensitivity, muscle strength decrease, and coordination of movements is often disturbed. In older and old people
the duration of an individual minute "decreases" and the speed of a simple motor
reactions. For elderly and senile people, social and mental maladjustment is characteristic, the causes of which are: retirement; loss of loved ones; limiting the ability to communicate with survivors; self-service difficulties; deterioration of the economic situation; dependency on others. This leads to the development of feelings of inferiority, powerlessness and loneliness in older age groups, which contributes to the development of psycho-emotional disorders (anxiety, agitation, depression, mania, delirium, cognitive decline). For example, manifestations of depression are observed in 60 and 20% of patients of older age groups, respectively, with severe and mild disease. It has been found that depression
along with impaired vision and coordination are a significant factor in accidental falls in the elderly. The nurse needs to remember
about persons of older age groups with an increased risk of developing psycho-emotional disorders,
contributing to falls. These are patients aged 80 and over who live alone, including widowers; couples living in isolation, including those without children
spouses; persons suffering from serious illnesses and physical ailments; forced to live on a minimum state allowance.
Major risk factors for falls
occurring in elderly and senile age: violations of maintaining balance; walking disorders; consequences of a stroke; pathology
joints; visual impairment; orthostatic hypotension; violations of cognitive (cognitive functions); depression; simultaneous reception of patients
entom 4 medicines and more.
The likelihood of falls increases with the number of risk factors:

in persons without risk factors, falls occur in 8% of cases,
in persons with 4 risk factors or more - in 78%.

The risk of falls increases significantly with the development of a new or exacerbation of a chronic somatic disease in a patient. In the elderly, dizziness and orthostatic hypotension (a condition in which, after
a sharp transition from a horizontal to a vertical position, the blood does not have time to enter the brain in sufficient quantities, resulting in dizziness, darkening in the eyes, impaired
there is an equilibrium). At the same time, 30% of patients fall out of bed (mainly in the evening and at night when trying to get up), 28% - from chairs and chairs that do not have
locking mechanisms, 20% - in the toilet (mostly women, getting up from the toilet after emptying the bladder).
Taking many medications changes the state of vascular tone. These are diuretics (furasemide, hypothiazide), drugs to reduce blood pressure(clofelin, co-
rinfar, enalapril, perindopril, lisonopril), β-blockers that slow down heart rate (metoprolol, atenolol), nitrates, anticonvulsants, benzodiazepines (diazepam, clonezam, phenazepam), antidepressants, hypnotics and sedatives. Significantly increases the risk of falling taking several of these drugs at the same time. Alcohol abuse contributes to the statistics of falls in the elderly. With the age-related decrease in visual acuity, it is necessary to choose the right glasses. Walking without good glasses, especially at dusk on the dark staircase of the entrance or the broken asphalt of the yard, often leads to a fall.
People who fall often need a medical examination to exclude conditions such as heart rhythm disturbances, epilepsy, parkinsonism, anemia, transient (transient) cerebrovascular accident, carotid sinus syndrome. The development of the latter is associated with the bending of the vertebral arteries that feed the brain in osteochondrosis of the cervical spine. In people suffering from osteochondrosis, a sudden clouding of consciousness is possible, as a result of which a fall occurs.
The risk of falling is high in people who are little, no more than 4 hours a day, are in an upright position, as well as in those who are unstable when standing, slow and depressed, cannot get up from a chair
without the help of hands. Elderly people suffering from syncope , in which there is a short-term blackout of consciousness, they need outside help and supervision when going outside
and especially in transportation. Syncopal conditions are caused by a decrease in oxygen delivery to the brain due to heart rhythm and conduction disturbances, tachyarrhythmias, drug overdose- nitrates, antihypertensive drugs, etc. Such elderly people need outside help when moving and organization
safe home.
External causes of falls associated with improper organization of safe movement (uncomfortable shoes, bad glasses, lack of assistive devices - canes, walkers), and home security, internal - with age-related changes in the musculoskeletal system, organ
vision and cardiovascular system.
Whatever the factors contributing to falls, they should be considered, avoided and prevented.
Conditions in which in the elderly and senile age, care must be taken do not go out alone when there is ice, at dusk,
in fog or snow: balance and gait disorders; dizziness; confusion; vision loss; syncopal states.
If an older person has fallen in front of witnesses and is seriously injured, their description of the fall can help the nurse understand the circumstances of the fall and correctly determine its cause.
Where do falls most often occur? In half of the cases - at home, especially in the toilet, bathroom and bedroom. Then come the hospitals, which often treat the elderly. Therefore, relatives
the staff of the hospital where the elderly patient is admitted should always be warned about the possibility of a fall. This question should be asked by the nurse to the patient and his relatives.
If the medical staff is aware of the patient's predisposition to falls, they will help to avoid them. Many patients (about 80%) fall without witnesses, which deprives them of quick help.
Outside the home, falls are more likely to occur on slippery sidewalks, wet pavement, when crossing a sidewalk curb, exiting public transport. Falls on the street without witnesses often lead not only to injuries, but also to hypothermia,
subsequent development of pneumonia, urinary tract infections and other diseases.

In many foreign countries, there is a practice when a patient is admitted to a hospital, already in the emergency department, to make a special diagnosis “falls” (“falls”) on the front side of the medical history. This orients the medical
the need to comply with fall prevention measures, a thorough examination of the patient and the importance of the consequences of a fall.
It must be remembered that the deterioration of the course of the underlying disease, a change of scenery, including hospitalization, are for an elderly patient
stressful situation (violation of established life stereotypes - familiar environment, communication with loved ones), which can lead to decompensation of mental status (depression or delirium).

The 1st week of hospitalization is especially dangerous. Patients begin to refuse food, poorly navigate the environment. There may be episodes of confusion, incontinence
urine, unexplained falls. The risk associated with hospitalization of elderly and senile people,
may exceed the risk of the cause of hospitalization. Patients with cerebrovascular disorders, mild forms of depression and dementia react especially sharply to hospitalization. In such patients, mental decompensation occurs quickly and sometimes unexpectedly for others (nurses, doctors, roommates, relatives).
status, which contributes to falls with corresponding consequences.
Nursing examination of patients with falls includes a survey, a physical examination, a study of the patient's ability to move independently and an assessment of the patient's environment.
The nurse asks the patient and his relatives about cases of falls during last year, clarifies their features: place; suddenness; provoking factors: inclinations and movements; shoes and clothes; environment; lighting; noise; medications and alcohol. Elderly patients with mental disorders and deterioration
memories may not remember episodes of their falls; in these cases, relatives or caregivers should be contacted for information.
Questions for the patient and family to help the nurse develop a fall prevention plan:
Have there been falls before?
if so, how frequent and predictable are they?
What time of day do they occur most often?
falls;
where did the fall occur: on the street, stairs, at home (toilet, bath)?
what caused the fall: getting up quickly from a bed, a chair, a toilet bowl, turning and tilting the torso, reaching for objects located high?
was there any alcohol intake?
Does the patient suffer from epilepsy?
does he have heartbeats and interruptions
in the work of the heart?
Is blood pressure monitored and does the patient remember the numbers?
Does the patient have diabetes mellitus, does he receive insulin preparations?
how many drugs are the patient taking at the same time (taking 4 or more drugs significantly increases the risk of falling)?
Has there been a recent hospitalization or limitation of movement within the next 2 months?
It is necessary to find out what medications the patient is receiving; whether there was a break in their reception (especially antiarrhythmic); whether their doses and regimen have changed; were appointed in recent times new medicines.
The nurse needs to find out not only the conditions in which falls occur, but also the accompanying symptoms; the time of day when the fall occurred and the behavior of the patient after it.

Functional tests to assess the risk of falling.

Get up and go test , performed on time. The test requires a chair with armrests (seat 48 cm high, armrest height 68 cm), a stopwatch and a space 3 m long. The patient is asked to get up from the chair, walk 3 m,
go around the object on the floor, come back and sit back on the chair. The patient is warned that the time it will take them to complete this action will be measured, and they can use any walking aids they are accustomed to (such as a cane). Normal result: the patient completed the test in 10 seconds or less,
doubtful – 11–29 p. If the test is completed in 30 seconds or more, this indicates a deterioration in the function
capacity and increased risk of falls.
Chair rising test . You need a chair without armrests, a stopwatch. The patient is asked to stand up from a chair 5 times in a row with arms folded on
chest, knees should be fully extended with each rise. The patient is told that the elapsed time will be measured. The test provides information about the strength and speed of the muscles of the lower extremities. A time of 10 seconds or less indicates good functionality, while 11 seconds or more reflects unsteady gait .
Balance test . The patient is asked to stand for 10 seconds in the “feet pressed together” position, then for 10 seconds in the “one foot in front of the other” position, and then in the “tandem” position. impossibility
standing in a tandem position for 10 seconds predicts a high risk of falling. If the patient is able to stand on 1 leg for less than 10 s, the risk of fractures increases by 9 times, and the inability to walk more than 100 m increases the risk of fracture.

Most common cause of death in elderly patients and old age from trauma received in re as a result of a fall, a fracture of the femoral neck. This is due to the fact that the nature of the fall changes with age: if younger people fall more often in the anteroposterior direction, then in the older groups, the fall to the side is most typical. Also important are osteoporosis and the generalized decrease in skeletal muscle mass (sarcopenia) that develops in the process of aging, leading to a gradual loss of muscle mass and strength, which causes a significant increase in the incidence of hip fractures in people over 75 years of age. Treatment (with canned
active tactics), as a rule, long-term, sometimes up to 6 months. Patients are forced to lie in a cast for a long time, and then for several months to restore motor activity, suffer from
stable pneumonia, infections, bedsores.

In 20% of cases of hip fracture, death occurs from complications. Half of the elderly patients after this injury become deeply disabled, in need of constant care. A large proportion of fall injuries in the elderly are fractures of the bones of the wrist . The process of accretion is
takes a lot of time - from 6 weeks to 3-6 months - and significantly limits a person's ability to self-service.

Spinal fractures are often painless and occur almost imperceptibly. After a while, the fracture becomes noticeable in the form of a "senile hump". For the treatment of such
injury requires a long period (1-2 years) without the certainty of a full recovery. Statistically, older women fall and get injured more often.
men. This is due to the fact that women at this age suffer from osteoporosis - increased bone fragility. In addition, older women live longer than men, and there are more of them.
The tendency to fall again is considered to be one of the components of the "standard frailty phenotype", which is characterized by a combination of 3
and more of the following: causeless weight loss; weakness; lack of strength; slow speed walking and low physical activity. Patients who, according to the specified criteria, are determined to be infirm, have increased risk falls, fractures (including
hips) and death.
Treating the consequences of falls is costly for both the patient and society. A person has to go through a mental trauma: to regain confidence in their physical strength, to overcome
fear of repeated falls. The consequences of a fracture are often a loss of independence, the need to hire a nurse, ask relatives for help,
friends. The restriction of the ability to move makes the convalescent lie down for a long time, which adversely affects his condition: there are
constipation, bedsores, due to age-related violations of thermoregulation - hypothermia and pneumonia. Often
it happens that, after undergoing a complex operation on the femoral neck and spending a lot of effort and money on treatment, an elderly person dies of pneumonia or sepsis caused by bedsores. In general, the world
statistics of injuries and deaths of older people as a result of a fall looks like this:

60% of older people over 65 are hospitalized as a result of a fall;
15–20% of them have fractures;
5–20% die from complications;
40% after discharge lose their independence and become dependent on others.

The analysis of these data leads to the conclusion that it is necessary to take
measures to prevent falls and fractures. The UN defined the rights of the elderly and old people from socio-political positions: INDEPENDENCE, PARTICIPATION, CARE, Dignity (Vienna International
native plan on aging, 1982). The concept of active longevity and promotion of health, as opposed to a long dependent life, provides for independence from the material and physical assistance of relatives or social
al workers, from diseases and ailments, from material conditions.
Elderly people need to be encouraged to be more attentive to their health; For this, it is necessary to use any possibilities of their
training on: diet; physical exercise; creating a favorable environment; risk factors for disease development; changes
habits and cultural traditions negatively affecting health.
The Importance of Physical Activity in the Elderly
people for the prevention of falls is also confirmed in the "Global recommendations for physical activity
activity for health” (WHO, 2010):
older people should engage in at least 150 minutes of moderate-intensity physical activity per week, or do at least 75 minutes of high-intensity aerobic exercise per week, or have an equivalent amount of moderate to vigorous physical activity;
aerobic exercises should be performed in series lasting at least 10 minutes;
for additional health benefits, increase the duration of moderate-intensity aerobics to 300 minutes per week, or do aerobics
high intensity up to 150 minutes per week, or have an equivalent amount of moderate to vigorous physical activity;
older people with mobility problems should do balance and fall prevention exercises for 3 or more days
in Week;
strength exercises should be done
engaging the main muscle groups, 2 or more days a week;
if older people cannot get their recommended amount of physical activity, they should do exercises that are appropriate for their abilities and health conditions.
Regular exercise produces positive physiological results: it helps regulate blood glucose levels; neutralize the negative effect of catecholamines (adrenaline and norepinephrine); improve the quality of sleep, the functioning of all elements of the cardiovascular system; strengthen the muscular system, which prolongs the period of independence in old age; exercises that stimulate movement help maintain and restore flexibility, "postpone" the onset of age associated with poor coordination of movements, which is the main cause of falls.
Physical exercise has a positive effect on the psychological status:
reduce manifestations of depression and anxiety;
can reduce the negative effects of stress.

Physical activity contributes to:
maintaining and strengthening social status (helps to play a more active role in production activities, family and society life);
reduces the cost of medical and social care.
Fall Prevention . It has been found that 15% of falls in the elderly are potentially preventable. Elderly fall prevention programs should include the following components (WHO):
inspection of the household environment to identify risk factors for falls;
measures to identify risk factors (checking and changing medical prescriptions, treatment of low blood pressure, additional prescription of vitamin D, calcium, and treatment of visual impairment);
assessing home conditions and changing environmental conditions in people with known risk factors or those who have already had falls;
prescribing appropriate assistive devices for physical and sensory impairments;
strengthening muscles and restoring vestibular function;
training in fall prevention and exercises aimed at maintaining dynamic balance and developing strength;
the use of special hip protectors for people at risk of hip fracture due to a fall.
Home and home security mainly depends on the organization of space in the apartment, the arrangement of furniture, the availability of auxiliary devices in the bathroom and toilet that allow an elderly person to perform the necessary procedures. It is not uncommon for a fall to occur in a bathroom on a slippery floor. It is better to replace the bathtub with a shower by placing a special chair (adjusted chair), sitting on which you can wash. If this is not possible, be sure to put a rubber mat with suction cups on the bottom of the bath, wash standing or sitting on a special seat for the bath. If an elderly person intends to take a bath lying down,
it must be remembered that you should first fill the bath with water of the desired temperature and only then enter
into her. This reduces the risk of burns from hot water. For the elderly, a water temperature of 35–36°C is recommended, warmer water should be avoided. Do not direct the jet of hot water at your head. In general, weakened older people should not wash alone, it is recommended to seek help from relatives or social workers. People with the risk of falling should not close themselves in the bathroom and toilet.
Older people with impaired vision move around the apartment by touch or memory, focusing on furnishings, touching furniture. Getting into an unusual environment - into someone else's
apartment, hospital or boarding school, they get lost, fear appears, sometimes confusion. Carpets, threshold rugs, thresholds, glass doors, dark long corridors, cluttered passages with things can provoke a fall. Every detail must be carefully considered to make the old man's life safe. Handrails are best placed next to the bathtub and toilet on
wrist joint level. Sometimes handrails are installed next to the bed, in the corridor, in places where there are steps. If an elderly person uses a cane or walker, they must be correctly selected - the handle must be on
wrist joint level. If one side of the body is weakened after a stroke or injury, use the stronger hand to lean on the cane.
Most of the day, an elderly debilitated person spends in the bedroom, where falls also often occur. This may be due to an uncomfortable, too high or too low bed, sagging mattress, lack of
a device that you can reach with your hand while lying in bed. The height of the bed should be about 60 cm depending on the height of the person. Legs can be extended if needed.
beds so that the elderly person can easily get on and off the bed. It is better to choose a mattress individually - not too soft, best of all - orthopedic. If this is not possible, the mattress should be evaluated according to several parameters. A mattress that easily deforms under the weight of a person, quickly forming holes, lumps, poorly supported
given to hygienic processing, not suitable. Too soft mattress badly affects the condition of the spine, causing pain and suffering. The bedside table should not be too far from the headboard, it is recommended to place a night light or a regular lamp with adjustable light intensity on it.
Since sleep is often disturbed in older people, they often wake up, read at night, and sometimes take medication. That's why everything necessary items- glasses, books, newspapers, medicines,
water for drinking, a watch, a telephone - should lie next to the headboard. This will help to avoid walking around the room at night and reduce the risk of falling. In cases where getting out of bed at night is unavoidable
succeeds, especially in men with prostate disease, patients with heart failure who have nocturnal enuresis, people who
suffering from kidney failure, you need to provide sufficient lighting for the night "route". In a state of semi-drowsiness, especially in poor lighting, nightfalls often occur.
Denia. On the way to the toilet there should be no wires, extra items, shoes, pet bowls, bags and other items. next to the bed
at night there should always be a ship or a duck, and bedridden patients should wear diapers at night. If the apartment (house) has a staircase, it should be with railings, and it is better to paint the first and last steps of the stairs in
met color (yellow, white, red); a rubber strip 2-3 cm wide is glued to the edge of each step so that the sole does not slip off.

Home shoes should be well matched to the foot, should not slip on linoleum and parquet, the heel should be low, and the heel should be soft. If it is difficult for a person to lace up shoes, it is advisable to sew wide elastic bands instead of laces or make a Velcro fastener. Slippers without backs are not recommended as home shoes, wearing such shoes increases the risk of falling, the foot is unstable in them, and slippers often slip off the foot. An elderly person is not recommended to independently get objects from the upper shelves and mezzanines, stand on ladders and chairs, since in this case the arms and head are raised up, dizziness often occurs, leading to falls, and the injury that most often occurs with such a fall is a fracture of the neck hips. The chair of an elderly person, in which he spends quite a lot of time, should be shallow, with a high back and headrest, with low comfortable armrests. It is important that the edge of the chair does not press on the popliteal fossae, as this impairs blood circulation in the legs and increases the risk of thrombosis,
thromboembolism.
Diet plays an important role in the prevention of falls. The adverse effect of alcohol on the cardiovascular system of an elderly person has been proven, its consumption often causes a fall. In some elderly people with vascular diseases of the internal organs, after a hot and plentiful meal, blood flow to the stomach increases and decreases -
to the brain. This causes an attack of lightheadedness, dizziness, blackouts in the eyes and can lead to a fall. In such cases, the patient is advised to limit the amount of food taken at one time, eat fractionally, often, in small portions. After eating, you should lie down.
The complexity of teaching the principles of healthy eating and giving up bad habits is well known. A.P. Chekhov in a letter to A.S. Suvorin reported: “In general, in my practice and in home life noticed that
when you advise old people to eat less, they take it almost as a personal insult.

It is necessary to remember about malnutrition as a cause of falls. In the elderly and old, this may be due to socioeconomic insecurity, physical infirmity, isolation, domestic inconveniences, dental problems, and reduced nutritional requirements due to low physical activity. If older people have problems with gait, balance and an increased risk of falls,
the nurse should discuss with the doctor the feasibility of prescribing vitamin D, which reduces the incidence of falls by more than 20%.
Nurse advice for an elderly patient on safety ness of his physical activity and life. Do not lift heavy things, do not strain your back, do not carry objects heavier than 2 kg, carry the load in front of you, pressing it against your body. When walking, especially outdoors, use a cane or walker. Purchase special protective shields that protect the femoral neck from fracture. They are invested in shorts and not
interfere with walking. Do not make sudden movements that may make you dizzy or cause displacement of the vertebrae. Sitting on a chair or in an armchair, neither
when not leaning to the side to get something off the floor. If you want to pick up an object from the floor, do not bend over, sit down with a straight back and pick it up. If you have had a fracture
neck of the femur, use another safe method - rest your hand on a table or other stable support, stand on an uninjured leg, bend your torso and at the same time remove the injured
giving the leg back, and with your free hand, get the object. When waking up, do not get out of bed too abruptly, as reflex reactions do not have time to provide adequate blood flow in the vessels
brain and may feel dizzy. The spine in the first 15 minutes after waking up is also very vulnerable. First, slowly take an upright position in bed, leaning on your hands behind
back, legs slightly bent and crossed at the ankles, then simultaneously turn the pelvis and legs to the edge of the bed, bring your legs together and slowly get out of bed. Do not get up abruptly from a chair or chair. Avoid deep, too soft and low chairs. You can not sit on a chair or chair with your legs crossed if you have had surgery
hip joint. Try to sit in a chair or chair with your legs at right angles to your body. The most suitable chairs and armchairs for you
those that have adjustable seat height and backrest and have armrests. Get up, leaning with both hands on the back of a chair or armchair.

Stand correctly, leaning on both feet, heels together, toes apart, or feet shoulder-width apart. If a If you have hip joint surgery, always turn back and sideways only slowly, turning your legs and pelvis at the same time. Neverstand and do not walk for too long, take small breaks to rest.

Dressing in old age is difficult, so it isuse simple fittingsunderwear, clothes and shoes. For clothes do"long arms", take 2 slats 35–45 cm long,Attach a clothespin at the end of eachor clip from suspenders. Clip the belt with clothespinsor an elastic band of that piece of clothing that is sobitry to put on - shorts, trousers or a skirt, takeslats at the ends and, sitting on a chair, put on underwear.When you pull up a wardrobe item enough youjuice, unfasten the clothespins and put on the laundry with your hands.Having trained, with the help of "long arms" you canwear socks and stockings. To wear socksbetter, attach the rail to the shoe horn andguide them to the heel of the toe. Put on shoes and bootscan be done with a regular chair. Get in front ofa chair, hold on to the back with your right hand, to the lefttake a shoe, bend your left leg and put it onleno on the seat of the chair. Put a shoe on your footTake off your leg and arm and put on another shoe.

A special shoe board with a V-shaped notch at one end and a bar nailed to the middle at the bottom will help to take off shoes and boots. Put one foot on the end without a drink, press the board
to the floor, the end with a cut will be raised up thanks to the bar. Insert the heel of the shoe on the other foot into the V-notch and remove the foot from the shoe. Do the same with the other shoe.
Some devices help you to use the toilet and bathroom safely. Extend the toilet to a comfortable height for you so that your legs are bent at a right angle. Sit on the toilet seat and stand up, holding on to the handrails built into the walls and leaning on both legs. For washing in the bath, use a special stool of the same height as the bath or a little higher, a hinged bath seat, a special rubber mat with suction cups. Lay a rubber mat on the bottom of the tub, sit on a stool,
throw one leg into the bath, then the other. Hold on to the handrail on the wall and once both feet are in the tub, slowly get up and sit on the hanging seat. Exit the bath in the same way after washing. Instead of a hinged seat, you can mount a folding seat in the wall above the bathtub. Use a sponge or brush to wash your feet
on a long handle. At home, a nurse, after consulting a doctor, can recommend simple sets of exercises to the patient.
Avoid sudden movements.

Several exercises to strengthen the muscles and ligaments of the lower extremities

Starting position - standing, legs together, hands on the waist. Raise your straight leg forward and up, slowly move it to the side, return to the starting position. Repeat with the other leg.

The starting position is the same. Raise your leg forward and up, bend at the knee, unbend, return to the starting position. Repeat with the other leg.
The starting position is the same. Squats at a moderate pace.
Starting position - standing, feet shoulder-width apart, hands on the waist. Sit down slowly, keeping your heels on the floor, as low as possible, slowly return to the starting position.
Starting position - standing, legs together, hands down. Lunge with your foot forward, putting your hands on your knee, return to the starting position. Repeat with the other leg.
The starting position is the same. Rise on your toes, return to the starting position.

Several exercises to develop and maintain flexibility

Starting position - standing, feet shoulder-width apart, hands on the waist. Tilts forward, sideways, back.
The starting position is the same. Circular movements of the body to the right, then to the left.
The starting position is the same. Lean forward, try to reach the sock with your right hand
left leg, repeat with the other arm.

Exercises to strengthen muscles and ligaments abdomen and pelvis

Starting position - sitting on the floor, hands rest on the floor behind your back. Alternately bend and unbend your legs at the knees.
Falls of people are caused by many internal and external factors. Persons who fall regularly require a thorough evaluation that includes a detailed history, examination, and assessment of functional status. Fall prevention involves the treatment of acute and chronic diseases of the nervous, cardiovascular, hematopoietic systems, musculoskeletal system, organs of vision, hearing, etc., as well as increased physical activity, systematic exercise therapy. In the preventive plan, it is obligatory to assess the home environment and, if necessary, correct it, and create a safe intrahospital environment.

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Faculty of Fundamental Medicine

Moscow State University named after M.V. Lomonosov

Department of Internal Medicine

Fall Syndrome

Completed:

6th year student 602 groups

named after M.V. Lomonosov

Snitsar Stepan Vyacheslavovich

Moscow 2015

Introduction

The study of the features of postural instability and risk factors for falls in people aged 65 years and older continues to be one of the urgent problems of gerontology and geriatrics and the whole complex of sciences about an aging person. In domestic literature, when talking about falls in people in the elderly and senile age, the term is often used not "postural instability", but "fall syndrome", however, this term is advisable to use if people aged 65 years and older have two or more falls during the year . Although the term "fall syndrome" is not used in modern foreign publications, the presence of two or more falls in the elderly is recognized as the most informative and recurrent indicator in describing this problem, which in foreign publications is denoted by the term "fallers".

Today it is known that the development of postural instability and, as a consequence of this fall, in people 65 years of age and older have a significant impact on their quality of life. The quality of life (QoL) in elderly and senile people is based on subjective perception, it depends primarily on health and is an integral indicator of the body's functional capabilities.

There is evidence that 30% of people aged 65 years and older experience falls at least once a year, while about half of them experience falls more than once a year. This figure is even higher among elderly patients in hospitals and nursing homes (40-60% of cases).

Falls are responsible for 6% of emergency hospital admissions in elderly patients. In the US, there are approximately 9,500 deaths per year due to falls. Mortality in the next 6 months. increases significantly in patients who have been lying on the ground for 6 hours or more after a fall. In these cases, the risk of developing compression syndrome increases, which is also aggravated by atherosclerotic processes characteristic of this age.

Falls, regardless of the cause that caused them, by themselves can lead to severe maladaptation of patients in Everyday life. In about 1 in 10 cases, they are accompanied by severe injuries, including fractures. In addition to trauma and associated disability, almost 50% of older adults who have experienced repeated falls have a limitation in physical activity due to psychological reasons. Thus, in persons aged 65-89 who have experienced at least one fall, compared with persons of the same age who have not experienced a single fall during the year, there is a significant decrease in the quality of life. Overall, it is estimated that the cost to society of falls in the United States exceeds $12 billion a year.

All of the above confirms the relevance of studying falls and their causes in elderly and senile people, the development of methods for the prevention and rehabilitation of people who have already encountered this problem.

1. Risk Factors for Fall Syndrome

Held many scientific works to identify risk factors for falls. One of the latest studies, which included 66,134 postmenopausal women under the age of 65 (more than half) and over 65, showed a high incidence of falls - 38.2% of women fell at least once a year. The most significant risk factor for falls was a history of falling (OR 2.7).

In addition, 17 other independent risk factors for falls were identified. The data from this study are presented in Table 1. The combination of several risk factors obtained in the study further increased the risk of falls. In addition, other studies have found that a decrease in serum vitamin D levels (25(OH)D<40 нг/мл, по некоторым данным <20 нг/мл) повышает риск падения. В этой связи интересным кажется увеличение в исследовании NORA риска падений у пациентов с заболеваниями почек и печени, а также с ожирением. Действительно, основная часть нативного витамина D находится в жировом депо.

In obese patients, vitamin D deficiency can develop even when it is normally taken into the body due to excessive absorption by adipose tissue. However, the biological effects on bone tissue and muscles are not provided by native vitamin D, but by its active form, the D-hormone. The transformation of cholecalciferol into D-hormone is shown in Figure 2. Impaired liver and/or kidney function leads to impaired formation of D-hormone and, as a result, a decrease in its biological effect on bones and muscles. As a rule, the function of 25-hydroxylase suffers only in severe liver damage - cirrhosis, while the decrease in glomerular filtration rate (GFR) is less than 65 ml / min. enough to significantly impair the function of 1-a-hydroxylase and reduce the synthesis of D-hormone. In a study of 1781 men and women with osteoporosis, this age-related decline in kidney function was found to be an independent risk factor for falls and reduced patient function (poor performance on functional tests). The importance of the D-hormone for muscle development and functionality has been demonstrated in many studies. Birge and Haddad back in the mid-1970s. showed that 25(OH)D3 affects phosphate metabolism in the diaphragm muscle of vitamin D deficient rats. muscles. To date, D-hormone has been shown to influence skeletal muscle at the genetic level (altering gene transcription) and at the tissue level through the regulation of calcium metabolism and the control of muscle contraction and relaxation. The importance of the effects of D-hormone on the balance response has been further confirmed recently by two prospective genetic studies. Vitamin D receptor polymorphisms have been found to lead to increased falls and reduced muscle strength.

With age, especially in the elderly, there is a decrease in the expression of the D-hormone receptor. It is not possible to assess its degree in real clinical practice. However, in a number of guidelines, in particular in the German clinical guidelines, functional tests are proposed to assess the risk of falling in outpatients: the “get up and go on time” test, the “rising from a chair” test.

To perform the "get up and walk on time" test, you need a chair with armrests (seat 48 cm high, armrest height 68 cm), a stopwatch and a space 3 m long. The patient is asked to get up from the chair, walk 3 m, walk around the object on the floor, return and sit back in the chair. The patient is warned that the time for which he (a) will perform this action will be measured, the patient can use any habitual devices for walking (for example, a cane). If the time for which the patient completed the test is 10 s or less, this is the norm, 11-29 s is a dubious result, a complex decision, based on other clinical data, 30 s or more indicates a deterioration in functionality and an increase in the risk of falls. A 2.6 second increase in test time has been shown to be associated with a 24% increase in the risk of non-vertebral fractures. To carry out the "rising from a chair" test, you need a chair without armrests, a stopwatch. The patient is asked to stand up from a chair 5 consecutive times with arms folded across chest, knees fully extended on each rise. The patient is told that the elapsed time will be measured. The test mainly provides information about the strength and speed of the muscles of the lower extremities. The time spent on the rise, equal to 10 seconds or less, indicates good functionality, 11 seconds or more - reflects the instability of the gait.

Quite often, the balance test is used. The patient is asked to stand for 10 seconds in the "feet pressed together" position, then 10 seconds in the "one foot in front of the other" position, and finally in the "tandem" position. The inability to stand in a tandem position for 10 s predicts a high risk of falling. In addition, an eight-year prospective study of 2928 postmenopausal women identified the most relevant tests for assessing fracture risk associated with an increased risk of falls and frailty in elderly patients. Thus, the inability to stand on one leg for 10 s increases the risk of fractures by 9.11 times (95% CI 1.98-42.0), and the inability to walk more than 100 m, determined by the patient, increases the risk of ankle fracture by 2, 36 times (1.10-5.08), hips - 11.57 times (2.73-49.15) and vertebral fractures - 3.85 times (1.45-10.22).

So, we can identify the main risk factors for falls in the elderly and senile age:

balance disorders,

walking disorders,

paresis,

joint pathology,

vision impairment,

orthostatic hypotension,

cognitive dysfunctions,

· depression,

Simultaneous intake by the patient of 4 drugs or more.

The likelihood of falls increases with an increase in the number of risk factors: in people without risk factors, falls occur in 8% of cases, in people with 4 or more risk factors - in 78%. Only a small percentage of falls are due to a single factor. It should be emphasized that the risk of falls increases significantly with the acute development or exacerbation of chronic somatic diseases.

2. Consequences of falls

One of the serious problems associated with the fall syndrome is the occurrence of injuries: fractures, subdural hematomas, severe injuries of soft tissues and the head. The frequent occurrence of fractures in elderly and senile people is due to osteoporosis, general weight loss, pathology of the joints, especially the lower extremities. The most common fractures are those of the proximal femur and humerus, distal arms, pelvic bones, and vertebrae. The risk of fractures due to falls is especially significant in patients who have impaired motor functions (paresis, ataxia) after a stroke. postural fall senile hematoma

However, injuries are far from common, while the quality of life is often reduced in people who have not suffered a fall-related injury. Numerous studies have noted that although most falls do not result in serious physical injury, their psychological and functional consequences can be much more serious for people 65 years of age and older. It has been established that the development of the syndrome of falls in the elderly has not only physical, but also psychological consequences and can cause serious psychological trauma, affecting the general psycho-emotional state and social activity of an aging person, leading to the development of another syndrome - post-fall syndrome. ).

This category of people develops a feeling of fear, fear of repeated falls, a feeling of anxiety, as a result of which they stop leaving the house, which is accompanied by an increase in dependence on others and greatly increases the burden on relatives and friends.

The emergence of a feeling of fear of possible falls in persons with postural instability has an objective basis in the form of more pronounced violations of the postural control system.

To assess changes in the quality of life, there are three main components:

1) Physical health component of quality of life (FCCL): physical functioning; general health; role functioning due to physical condition; pain intensity.

2) The psychological component of the health of the quality of life (PKKZH): mental health, vitality; social functioning; role functioning due to the emotional state.

3) General indicator of quality of life (QOL). All components of the scales.

It has been shown that even minor changes in the postural balance will negatively affect all components of QoL in the elderly.

3. Prevention of falling syndrome

The development of the syndrome of falls in the elderly should be considered as a process of reducing the adaptive capabilities of the body and its functional systems at a late stage of ontogenesis, which confirms the need for the development and implementation of measures aimed at preventing premature aging in the elderly and senile.

It has been established that the discovery of the causes of unsteadiness during movements in the elderly, as well as reducing the risk of falls, can help improve their quality of life. It is known that one of the most effective ways to assess postural instability and the risk of falls in elderly and senile people is computer stabilometry (postulography).

Since today the assessment of the quality of life of older people is an important criterion for predicting their life expectancy and the effectiveness of providing them with medical and social assistance, it is necessary, when organizing medical and social assistance to people aged 65 years and older, to take into account the presence of falls as a criterion for reducing their quality of life, as well as deterioration functional state and health.

The introduction of computer stabilometry (postulography) into the practice of geriatrics will be useful for annual monitoring of the state of the postural control system in the elderly and senile, which will allow timely detection of changes in their postural control and reduce the risk of falls.

In order to prevent the development of the syndrome of falls, it is necessary to develop methods for the prevention and control of risk factors.

Bibliography

1. Volova A.A., Demin A.V., Moroz T.P. Features of the quality of life in women of senile age with the syndrome of falls // Bulletin of the Northern (Arctic) Federal University. Series: Biomedical Sciences. - 2014. - No. 3.

2. Gudkov A.B., Demin A.V. Features of postural balance in elderly and senile men with fear of falling syndrome. Uspekhi gerontologii. 2012. V. 25. No. 1. pp. 166-170.

3. Damulin I.V., Zhuchenko T.D., Levin O.S. Balance and gait disorders in the elderly. In: Advances in neurogeriatrics. Ed. N.N. Yakhno, I.V. Damulin. M.: MMA, 1995; 71-99.

4. Damulin I.V. Falls in the elderly and senile age // Consilium Medicum. - 2003. - V. 5. - No. 12. - S. 67-82.

5. Demin A.V. Features of postural instability in men aged 65-89 years (epidemiological analysis) // Journal of scientific publications of graduate and doctoral students. 2010. No. 8. pp. 111-114.

6. Demin A.V. Features of the quality of life in men aged 65-89 depending on postural stability and instability // Young scientist. 2011. No. 9. pp. 241-244.

7. Ilnitsky A.N., Bakhmutova Yu.V., Litvinov A.E., Altukhov A.A. Clinical epidemiology of falls in the elderly and senile age in diabetes mellitus // Scientific Bulletin of the Belgorod State University. 2011. Issue. 16/1. pp. 33-36.

8. Litvinov A.E., Altukhov A.A. Clinical epidemiology of falls in the elderly and senile age in diabetes mellitus // Scientific Bulletin of the Belgorod State University. Series: Medicine. Pharmacy. - 2011. - T. 16. - No. 22-1.

9. Lord S.R., Close C.T., Sherrington C., Menz H.B. Falls in Older People: Risk Factors and Strategies for Prevention, 2nd Edition. New York: Cambridge University Press, 2007. 408 p.

10. Murphy J., Isaacs B. The post-fall syndrome. A study of 36 elderly patients // Gerontology. 1982 Vol. 28, no. 4. P. 265-270.

11. Spirduso W.W., Francis K.L., Edition P.G. Physical Dimensions of Aging. 2nd Mac Rae. Champaign. Illinois. USA: Human Kinetics, 2005. 384 p.

12. Stenhagen M., Ekstrom H., Nordell E., Elmstahl.S. Accidental falls, health-related quality of life and life satisfaction: a prospective study of the general elderly population // Archives of gerontology and geriatrics. 2014. Vol. 58, no. 1. R. 95-100.

13. Tideiksaar R. Falls in Older People: Prevention & Management, Fourth Edition. Baltimore: Health Professions, 2010. 312 p.

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Reasons for falling in old age

The best predictor of a fall is the previous fall. However, falls in the elderly rarely have a single cause or risk factor. The fall is usually the result of a complex interaction, including:

internal factors (age-related decline in functions, disorders and side effects of the use of drugs);
external factors (hazards from the environment);
situational factors (relating to the activity being performed, such as when rushing to the bathroom).

Internal factors. Age-related changes can disrupt systems involved in maintaining balance and stability (for example, standing, walking, or sitting). There is a decrease in visual acuity, contrast sensitivity, depth of perception and adaptation in the dark. Changes in muscle activation, structure, and ability to generate sufficient muscle strength and speed can impair the ability to maintain or restore balance in response to disturbances (eg, stepping on uneven ground, bumping into something).

Chronic and acute disorders and drug use are major risk factors for falls. The risk of falling increases with the number of drugs taken. Psychotropic drugs are most commonly cited as increasing the risk of falls and fall-related injuries.

External factors. Environmental factors themselves may also increase the risk of falls or, more importantly, when they interact with internal factors. The risk is greatest when the environment requires greater postural control and mobility (for example, when moving on slippery surfaces) and being in an unfamiliar environment (for example, when moving to a new home).

Situational factors. Certain activities or decisions can increase the risk of falls and fall-related injuries. Examples of this are chatter or distraction to dual task performance, multi-tasking and environmental hazard distraction while walking (e.g. curb or ledge), rushing to the bathroom (especially at night when there is not a quick wake from sleep or insufficient lighting and when rushing to phone calls.

Complications. Falls, in particular multiple falls, increase the risk of injury, hospitalization, and mortality, especially in frail older people with existing comorbidities and deficits in activities of daily living. Longer term complications may include decreased motor function, fear of falling, and institutionalization; falls are reported to account for 40% of nursing home stays.

More than 50% of falls in older adults result in injury. Although most injuries are not serious (eg, bruises, abrasions), fall injuries account for about 5% of hospital admissions among patients at least 65. About 5% of falls result in fractures of the humerus, wrist, or pelvis. About 2% of falls end in hip fractures. Other serious injuries (eg, head and internal injuries, cuts) occur in about 10% of falls. Some of the injuries are fatal. About 5% of older people with hip fractures die during hospitalization; overall mortality 12 months after hip fracture ranges from 18 to 33%.

About half of older people who are prone to falls cannot stand up without assistance. Spending more than 2 hours on the floor after a fall increases the risk of dehydration, pressure sores, rhabdomyolysis, hypothermia, and pneumonia.

Functions and quality of life can deteriorate dramatically after a fall; at least 50% of elderly people who were seen on an outpatient basis before suffering a hip fracture cannot regain their previous level of mobility. After a fall, older people may have a fear of falling again, because. mobility is sometimes reduced because confidence is lost. Because of this fear, some people may even avoid certain activities (eg, shopping, cleaning). Decreased activity may increase the combination of ossification and weakness, further reducing mobility.

Fall estimates in old age

Clinical assessment.
Performance testing.
Sometimes laboratory tests.

After treatment of major injuries, assessment aims to identify risk factors and appropriate interventions so as to reduce the risk of further falls and fall-related injuries.

Some falls are recognized immediately, because there is obvious injury from a fall, or there is concern about potential damage. However, because older people often do not report falls, they should be asked about them at least once a year.

Patients who report a single fall should be assessed for balance or gait disturbance using the Get Up and Walk Test. For testing, patients are observed as they rise from a standard chair, walk 3 m (10 ft) in a straight line, turn around, return to the chair, and sit in it. Observation can identify weakness in the lower extremities, imbalance in standing or sitting, unsteady gait.

In a more complete assessment of risk factors for falls, patients include those who:

have difficulty passing the "get up and go" test;
report frequent falls during screening;
are assessed after a recent fall (after a severe injury, identified and treated).

History and physical examination. When there is a need for a more comprehensive assessment of risk factors, the emphasis is on identifying internal, external and situational factors that can be reduced through interventions that target them.

Patients are asked direct questions about their most recent fall or falls, and then more specific questions about when and where the fall occurred and what they were doing at that time. Witnesses to the incident are asked the same questions. Patients should be asked if they had previous or fall-related symptoms (eg, palpitations, shortness of breath, chest pain, vertigo, dizziness) and if the patient lost consciousness. Patients should also be asked if any obvious external or situational factors may have been involved. The history should include questions about past and present medical problems, prescription and over-the-counter drug use, and alcohol use. Since it may not be possible to eliminate all risks of subsequent falls, patients should be asked whether they were able to stand up unaided after the fall and whether they were injured. The goal is to reduce the risk of complications that can be caused by subsequent falls.

The physical examination should be comprehensive enough to rule out obvious internal causes of falls. If the fall is recent, the patient's temperature should be taken to determine if the fever was a risk factor for the fall. Pulse and heart rate should be assessed for obvious bradycardia, resting tachycardia, or arrhythmia. BP should be measured in patients in the supine position and after patients have been in a standing position for 1 to 5 minutes to rule out orthostatic hypotension. Many types of heart valve defects can be detected on auscultation. Visual acuity should be assessed in patients wearing corrective lenses in their habitual presence, if necessary. Violations of visual acuity should require a more detailed visual examination by an ophthalmologist or ophthalmologist. The neck, spine, and extremities (especially the legs and feet) should be assessed for weakness, deformities, pain, and limited range of motion. A neurological examination should be performed; it includes checking muscle strength and tone, sensation (including proprioception), coordination (including cerebellar function), stationary balance, and gait. The Romberg test (in which patients stand with their feet together with their eyes closed) evaluates basic postural control and the proprioceptive and vestibular systems. Tests to determine high-level balance function include observation of the patient in a standing position on one leg and tandem gait. If patients can stand on one leg for 10 seconds with their eyes open and walk 5 m (10 ft) in tandem, any deficit in internal postural control is likely to be minimal. Physicians should evaluate positional vestibular function (eg, the Dix-Hallpike-Sidebar test).

Performance Tests. Performance is a rough estimate of mobility, or performing the Get Up and Walk test may reveal problems with balance and stability in walking and other movements and indicate an increased risk of falls.

Laboratory tests. There is no standard diagnostic evaluation. Testing should be based on history and expertise and help rule out various causes: CBC to confirm anemia, blood glucose measurement to determine hypoglycemia or hyperglycemia, and electrolyte measurement to establish dehydration. Investigations such as ECG, ambulatory cardiac monitoring, and echocardiography are recommended only if cardiac dysfunction is suspected. Guided carotid sinus massage (IV access and cardiac monitoring) has been proposed to detect carotid hypersensitivity and ultimately may initiate pacemaker therapy. X-ray of the spine, CT scan of the skull, or MRI is indicated only when history and physical examination identify new neurological abnormalities.

Fall prevention in the elderly

The emphasis is on preventing or reducing the number of subsequent falls and injuries caused by falls and complications, while at the same time maintaining as much of the patient's function and independence as possible.

Patients who report one fall and who do not have problems with balance or gait on the Get Up and Walk or similar tests should be provided with general information on reducing the risk of falls. It should include the safe use of drugs and the reduction of environmental hazards.

Patients who have fallen more than once and have problems during the initial balance and gait test should be transferred to a physical therapy or exercise therapy program. Physical therapy and a treatment program can be done at home if patients have limited mobility. Physiotherapists prescribe exercise programs to improve balance, gait, and correct certain problems that contribute to the risk of falling. More general exercise programs in health care facilities or community settings may also improve balance and gait. For example, a tai chi program can be effective and can be done alone or in groups. The most effective programs to reduce the risk of falls are those that are implemented taking into account the budget deficit of the patient, are provided by qualified specialists, have a sufficient balance of component signs (balance challange component) and are long-term (for example, at least 4 months).

Auxiliary devices. Some patients benefit from the use of assistive devices (eg, canes, walkers). The use of a cane may be adequate for those patients who have minimal unilateral loss of muscle strength, weakening of the joints, but walkers, especially wheeled walkers, are more suitable for patients with an increased risk of falls, weakness in both legs, or impaired coordination (wheeled walkers can be dangerous for patients who cannot adequately control themselves). Physiotherapists can help patients choose the shape or size of the device they are using and teach them how to use it.

Medical management of the patient. The use of drugs that may increase the risk of falls should be discontinued or dosages should be kept to a minimum. Patients should be evaluated for osteoporosis and, if osteoporosis is diagnosed, should be treated to reduce the risk of future fractures from falls. If any other specific disorder is identified as a risk factor, targeted interventions are needed. For example, medications and physical therapy can reduce the risk for patients with Parkinson's disease. Vitamin D, especially when combined with Ca, may reduce the risk of falls, especially in those patients who have low blood levels of vitamin D. Pain reduction, physical therapy, and sometimes joint replacement surgery can reduce the risk for arthritis patients. Replacement with suitable matching lenses (only lenses, not bifocals or trifocals) or surgery, especially cataract removal, can help patients with visual impairments.

Environmental modifications. Correcting an environmental hazard in a home can reduce the risk of falling. Patients should also be given advice on how to reduce risk due to situational factors. For example, shoes should have flat heels, some ankle support, and hard, non-slip midsoles. Many patients with chronic mobility limitations (eg, severe arthritis, paresis) benefit from a combination of medical, rehabilitation, and environmental strategies. Wheelchair accommodations (e.g., a removable footplate to reduce actuation during transfers, antitype baffle bars to prevent rearward tipping), removable straps, and a wedge seat can prevent falls for people with poor sitting balance or severe weakness when sitting or moving around.

Restraints can lead to subsequent falls and other complications and thus should not be used. Guardian supervision is more efficient and safer. Motion detectors may be used, but in such cases a guardian must be present to determine if an alarm has been triggered.

Thigh protectors (padding sewn into special underwear) can help protect patients who have experienced falls and are at risk of hip injury, but many patients do not want to wear protective clothing indefinitely. A resilient floor (eg, hard rubber) can help cushion the impact, but a floor that is too springy (eg, soft foam) can destabilize patients.

Patients should also be taught what to do if they fall and cannot get up. Benefits include turning from supine to prone, getting on all fours, crawling to secure support on the surface, and pulling up.

Injuries pose a serious threat to the health and life of adults and children.

Every year, millions of people on the planet, due to personal carelessness and negligence, or due to someone else's criminal negligence and irresponsibility, are injured, become disabled, lose their lives. If at a young age the case is often limited to bruises or abrasions, then older people receive serious injuries and fractures during a fall, which can seriously turn their whole lives upside down, lead to disability, immobility, dependence on others.

Firstly, due to the reflex regulation of movements, the correct work of the centers of balance and the vestibular apparatus.

Secondly, thanks to good eyesight, which allows you to correctly navigate the environment and avoid obstacles. Violation of at least one of these mechanisms increases the risk of falling. The cause of falls is the age factor, when in the elderly and senile age there are problems with gait against the background of neurological and vascular diseases, vision deteriorates, and dementia develops.

In addition, weather factors play an additional role: a slippery passable part of the street in winter, or its uneven surface, poor lighting, etc.

Taking many drugs changes the state of vascular tone, which leads to a fall. Especially increases the risk of falling taking several drugs at the same time.

Age-related decrease in visual acuity requires the correct selection of glasses.

People who fall frequently need a medical examination to rule out such ailments as heart rhythm disturbances, epilepsy, parkinsonism, anemia, transient (transient) cerebrovascular accidents, carotid sinus syndrome.

The risk of falling is high in people who are little, no more than 4 hours a day, are in an upright position, as well as in those who are unstable when standing, slow and depressed, cannot get up from a chair without the help of hands.

Elderly people suffering from syncope, in which short-term blackouts occur, require outside help and supervision when going outside and especially in transport. Such older people need outside assistance with movement and the organization of a safe home.

All causes of falls in old age can be divided into two large groups.

External causes associated with improper organization of safe movement: uncomfortable shoes, bad glasses, lack of auxiliary vehicles (canes, walkers); poor home security.

Internal causes associated with age-related changes in the musculoskeletal system, the organ of vision and the cardiovascular system.

Whatever the factors contributing to falls, they must be taken into account and every means should be used to avoid falling.

Conditions in which, in the elderly and senile age, care must be taken not to go out alone in ice, twilight, fog or snow

Balance and gait disorders;

Dizziness;

confusion;

visual disturbances;

Syncopal states - cases of short-term loss of consciousness.

Where do falls most often occur? 50% of cases occur at home, especially in the bathroom and bedroom. Many patients, about 80%, fall without witnesses, which deprives them of quick help.

The most common cause of death in elderly and elderly patients from injury resulting from a fall is a hip fracture. In 20% of all cases of hip fracture, death occurs from complications. Half of the elderly patients after this injury become deeply disabled, requiring constant care.

A large proportion of fall injuries in the elderly are fractures of the bones of the wrist. The process of fusion takes a long time, lasts from 6 weeks to 3-6 months and significantly limits the ability of a person to self-care.

Statistically, older women fall and get injured more often than men. This is due to the fact that women in old age suffer from osteoporosis - increased bone fragility.

Treatment of the consequences of falls is expensive for both the patient and his family. A person has to go through a mental trauma: to regain confidence in their physical strength, to overcome the fear of repeated falls. The consequences of a fracture are often a loss of independence, the need to hire a nurse, ask relatives and friends for help. The restriction of the ability to move makes the convalescent lie down for a long time, which adversely affects his well-being: constipation, bedsores occur, due to age-related violations of thermoregulation - hypothermia and pneumonia.

Fall prevention should be carried out in three main areas

Organization of safe living and housing;

Gymnastics to increase leg muscle strength;

The use of drugs to reduce the severity of dizziness and treat osteoporosis.

No matter what causes older people to fall, here are some tips to help prevent falls.

Regular exercise to strengthen muscles and bones;

Remove things from your home that could contribute to falls;

Store the necessary things in easily accessible places;

On the floor, use non-slip mats;

In the bathroom, make handles and railings;

Keep the stairs and hallway well lit;

When using drugs, be sure to ask your doctor about their possible effect on the bones (whether they cause them to break);

Wear comfortable shoes with non-slip soles; use orthopedic insoles to compensate for static foot insufficiency; use a cane or crutches for severe gait instability.

The safety of the home mainly depends on the organization of space in the apartment, the arrangement of furniture, the availability of assistive devices in the bathroom and toilet that allow an elderly person to perform the necessary procedures. It is not uncommon for a fall to occur in a bathroom on a slippery floor. It is better to replace the bath with a shower, put a special chair, sitting in which you can wash. If this is not possible, be sure to put a rubber mat with suction cups on the bottom of the bath, wash standing or sitting on a special seat for the bath. If an elderly person intends to take a bath lying down, one must remember that one should first fill the bath with water of the desired temperature and only then enter it. This will reduce the risk of scalding with hot water when washing. For the elderly, a water temperature of 35-36C is recommended, warmer water should be avoided. Do not direct the jet of hot water at your head. In general, it is impossible for the weakened elderly to wash alone, you need to seek help from relatives.

Older people with impaired vision move around the apartment by touch or memory, focusing on furnishings, touching furniture. Getting into an unusual environment - in someone else's apartment or boarding school, they get lost, fear appears, sometimes confusion of consciousness.

Carpets, rubber floor mats, thresholds, glass doors, dark long hallways, cluttered aisles can cause a fall. Every detail must be carefully considered to make the life of an elderly relative safe.

An elderly weakened person spends most of the time of the day in the bedroom, where falls also often occur. This may be due to an uncomfortable, too low or too high bed, a sagging mattress, the lack of a lighting fixture that you can freely reach with your hand while lying on the bed. The height of the bed should be about 60 cm depending on the height of the person. If necessary, you can build up the legs of the bed so that an elderly person can easily sit on the bed and get up. The bedside table should not be too far from the headboard, it is recommended to place a night light or a regular lamp with adjustable light intensity on it.

Since sleep is often disturbed in the elderly, they often wake up, read at night, and sometimes take medication. Therefore, all necessary items, such as glasses, books, newspapers, medicines, drinking water, watches, should lie next to the headboard. This will help to avoid walking around the room at night and reduce the risk of falling. If getting out of bed at night cannot be avoided, especially men with prostate disease, patients with heart failure, who have nocturnal enuresis, people suffering from kidney failure, adequate illumination of the night route should be provided. In a state of semi-drowsiness, especially in poor lighting conditions, night falls often occur. On the way to the toilet, there should be no wires, rugs, extra items, shoes, pet food bowls, bags and other items. A ship or a duck should always be near the bed at night, and bedridden patients should wear diapers at night.

Home shoes should be well matched to the foot and should not slip on linoleum or parquet, the heel should be low and the heel should be soft. If it is difficult for a person to lace up shoes, it is advisable to sew wide elastic bands instead of laces or make a Velcro fastener. Slippers without backs are not recommended as home shoes, wearing such shoes increases the risk of falling, the foot is unstable in it, the slippers often slip off the foot. ward, treatment room, toilet, dining room. Elderly people should always remember that at their age one should calculate their strengths and body capabilities. If possible, predict and foresee traumatic consequences in a given situation and thereby avoid injuries and injuries. Be attentive to your health!!!

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