Loss of balance and falls

| A fall is a sudden, involuntary and unexpected fall to the ground, with or without secondary injury, confirmed by the patient or a witness.

Due to their frequency, consequences and complications, they constitute by themselves a geriatric syndrome of great importance. About the 30% of individuals over 65 years of age fall each year; 5% of them have major injuries such as fractures, 2% require hospitalization and of these only 50% survive a year after the fall.

These figures refer to the elderly living in the community. As for the elderly who live institutionalized, the figures are more important: 50% of them fall each year, with a result of 10 to 25% of major fractures or injuries as a result. Thus, the popular idea of ​​serious deterioration and more than possible death of an elderly person after a serious fall is quite correct.

Almost 10% of falls are related to the onset of acute diseases (pneumonia, cerebrovascular accident, dehydration, fever ...), as an atypical form of presentation. For this reason, health professionals must actively seek new pathologies when an elderly person falls without apparent cause.

Walking is a primary function that:

• contributes to independence in activities of daily living.
• increases emotional well-being.
• increases cardiorespiratory rhythm.
• increases muscle strength.
• contributes to the maintenance of body weight.
• improves overall health.

For all this walk or marchIn addition to being an excellent exercise, it is a important pillar in the health of the elderly. Gait disorders and disorders are a frequent cause of disability in the elderly, with a significant increase in the risk of falls (with serious consequences in many cases), limit the performance of activities of daily living, lead to isolation of the individual and worsen , in general, the quality of life. Almost 15% of people over 65 have some alteration in the ability to walk and it is not always related to the normal aging process. Walking at normal gears requires a series of essential factors to its correct realization, What are they:

• Balance.
• Ability to achieve and maintain an erect posture.
• Ability to initiate and maintain the rhythm of the steps.

These requirements are met by a musculoskeletal and nervous system in correct operation. It is easy to recognize the typical walk of the elderly, characterized by:

• Small, short steps (from the hip).
• Minimal heel lift.
• Time increase over 2 feet.
• Decreased swinging of the arms and body rotations.
• Less flexion of the shoulders.
• Decreased travel speed.
• Block twists (due to decreased strength in the pelvic girdle muscles and loss of elasticity in muscles, tendons and joints).
• Body flexed forward, shifting the center of gravity anteriorly, which leads to difficulties in maintain standing and facilitates forward falls.

These changes, produced by muscle, tendon and joint alterations, can be associated with neurological problems (hemiparesis due to cerebrovascular accidents, Parkinson's disease, peripheral neuropathies, etc.), visual or balance pathology, cardiorespiratory disorders that cause drowning or all at once.

It is difficult to differentiate what is normal gait in the elderly and what is caused by pathology, so it is more useful to consider gait and walking disorders as an entity by themselves, with the risk of serious complications through the Geriatric falls syndrome in the elderly.