Falls Prevention York Region Health Department

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Falls PreventionYork Region Health Department

• A Psychiatrists Perspective
• May 14, 2007
• Dr. Ian Ferguson

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Geriatric Psychiatry and Movement

• Impaired mobility is a reflection of frailty
• Frail older adults have complex problems
• Most of my patients have a comorbid medical or
  neurologic disorder
• The decisions made by frail older adults are
  often life changing
• An old age psychiatrist must have a
  multidisciplinary perspective

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Points of Intersection

• Inpatient GARU, rehab, CCC, palliative
• Outpatient psychogeriatric clinic
• Community
• Home
• Assistive Living
• RH
• LTCF

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Inpatient

• Mental Status
• Cognitive Status
• Psychopharmacology
• Co-morbid conditions
• Discharge Planning
• Risk assessment
• Ethics

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Psychogeriatric Clinic

• What does the observed difficulty with movement
  tell us?
• Probable Gait Apraxia in absence of other
  neurologic pathology
• problems with IADL and ADL
• Risk for falls
• Cerebrovascular pathology
• Impairment of frontal lobe function

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Gait Apraxia

• Defn
• the loss of monitoring of the automatic
  implementation of gait mechanisms
• Synonyms HLGD, frontal ataxia.
• Includes Trunk, Stance, Gait
• Dissociation between Gait Apraxia and ideomotor
  apraxia, facial apraxia, and utilisation apraxia

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Trunk

• Problems with
• Transfers to and from sitting
• Transfers to and from lying down
• Turning around while standing
• Rolling over in bed

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Stance

• Problems
• Balance while standing, walking or negotiating
  turns
• Loss of anticipatory and reactive postural
  responses resulting in falls

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Gait

• Problems
• Ignition failure frozen or glued foot
• Deficits in stepping with shuffling
• Obstructive leg crossing or leg hypokinesia
• Temporary arrests of walking
• Difficulty with stopping and turning
• Cant walk and talk

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Community -Environment

• Home
• furniture walking
• Hoarding
• Safety vs independence
• Ability to manage ADLs and IADLs

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Community - Environment

• LTCF
• Layout and structure of the rooms and units
• Staffing
• Psychosocial variables
• Interpersonal
• milieu

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Summary

• Gait impairment, disequilibrium, and falls inform
  us about
• Possible neuropathology
• Impairment in other areas of function
• Increased frailty
• Necessity of a multidisciplinary view of a
  complex situation