Pasquetti Pietro, Apicella Lorenzo, Mangone Giuseppe
Specialization in Physical Medicine and Rehabilitation, Director of Recovery and Rehabilitation Agency, University Hospital of Careggi, Florence, Italy.
Postgraduate Specialization School in Physical Medicine and Rehabilitation, Recovery and Rehabilitation Agency, University Hospital of Careggi, Florence, Italy.
Clin Cases Miner Bone Metab. 2014 Sep;11(3):222-5.
Falls in the elderly are a public health problem. Consequences of falls are increased risk of hospitalization, which results in an increase in health care costs. It is estimated that 33% of individuals older than 65 years undergoes falls. Causes of falls can be distinguished in intrinsic and extrinsic predisposing conditions. The intrinsic causes can be divided into age-related physiological changes and pathological predisposing conditions. The age-related physiological changes are sight disorders, hearing disorders, alterations in the Central Nervous System, balance deficits, musculoskeletal alterations. The pathological conditions can be Neurological, Cardiovascular, Endocrine, Psychiatric, Iatrogenic. Extrinsic causes of falling are environmental factors such as obstacles, inadequate footwear. The treatment of falls must be multidimensional and multidisciplinary. The best instrument in evaluating elderly at risk is Comprehensive Geriatric Assessment (CGA). CGA allows better management resulting in reduced costs. The treatment should be primarily preventive acting on extrinsic causes; then treatment of chronic and acute diseases. Rehabilitation is fundamental, in order to improve residual capacity, motor skills, postural control, recovery of strength. There are two main types of exercises: aerobic and muscular strength training. Education of patient is a key-point, in particular through the Back School. In conclusion falls in the elderly are presented as a "geriatric syndrome"; through a multidimensional assessment, an integrated treatment and a rehabilitation program is possible to improve quality of life in elderly.
老年人跌倒属于公共卫生问题。跌倒的后果是住院风险增加，进而导致医疗保健成本上升。据估计，65岁以上的人群中有33%曾发生过跌倒。跌倒的原因可分为内在和外在诱发因素。内在原因可分为与年龄相关的生理变化和病理诱发因素。与年龄相关的生理变化包括视力障碍、听力障碍、中枢神经系统改变、平衡能力下降、肌肉骨骼改变。病理状况可能涉及神经、心血管、内分泌、精神、医源性等方面。跌倒的外在原因是环境因素，如障碍物、不合适的鞋类。跌倒的治疗必须是多维度和多学科的。评估有跌倒风险老年人的最佳工具是综合老年评估（CGA）。CGA有助于更好地管理，从而降低成本。治疗应首先针对外在原因进行预防；然后治疗慢性和急性疾病。康复至关重要，以提高残余能力、运动技能、姿势控制和力量恢复。主要有两种运动类型：有氧运动和肌肉力量训练。对患者的教育是关键，特别是通过背部学校。总之，老年人跌倒表现为一种“老年综合征”；通过多维度评估、综合治疗和康复计划，有可能改善老年人的生活质量。
