{"id":733,"date":"2025-11-12T17:42:43","date_gmt":"2025-11-12T14:42:43","guid":{"rendered":"https:\/\/tatd.org.tr\/geriatri\/?p=733"},"modified":"2025-11-12T17:42:44","modified_gmt":"2025-11-12T14:42:44","slug":"yaslilarda-kirik-spektrumu","status":"publish","type":"post","link":"https:\/\/tatd.org.tr\/geriatri\/genel\/yaslilarda-kirik-spektrumu\/","title":{"rendered":"Ya\u015fl\u0131larda K\u0131r\u0131k Spektrumu"},"content":{"rendered":"\n<p><strong>Yazar:<\/strong>&nbsp;\u00c7a\u011flar Kuas<\/p>\n\n\n\n<p><strong>Edit\u00f6r:<\/strong>&nbsp;Canan Akman<\/p>\n\n\n\n<p>T\u00fcrkiye ve d\u00fcnya genelinde ya\u015fl\u0131 n\u00fcfusun h\u0131zla artmas\u0131, acil t\u0131p prati\u011fimizin odak noktas\u0131n\u0131 ka\u00e7\u0131n\u0131lmaz olarak de\u011fi\u015ftirmektedir. G\u00fcn\u00fcm\u00fcz acil servislerinde, hastalar\u0131n \u00f6nemli bir b\u00f6l\u00fcm\u00fcn\u00fc \u00e7oklu komorbiditelere sahip ya\u015fl\u0131 bireyler olu\u015fturmakta, bu durum \u00f6zellikle travma y\u00f6netimini yeni bir boyuta ta\u015f\u0131maktad\u0131r. Geleneksel travma skorlama ve y\u00f6netim algoritmalar\u0131m\u0131z, bu \u00f6zel hasta grubunun biyolojik ve fizyolojik k\u0131r\u0131lganl\u0131\u011f\u0131n\u0131 tam olarak yans\u0131tamamaktad\u0131r. Basit bir ev i\u00e7i d\u00fc\u015fmesi sonucu acil servise ba\u015fvuran ya\u015fl\u0131 bir hastada, genellikle minimal travmaya atfedilen ancak y\u00fcksek morbidite ve mortalite riski ta\u015f\u0131yan bir kal\u00e7a k\u0131r\u0131\u011f\u0131 veya omurga frakt\u00fcr\u00fc ile kar\u015f\u0131la\u015fmak art\u0131k rutindir. Bu yaz\u0131m\u0131zda, bu klinik zorlu\u011fun temelini olu\u015fturan&nbsp;<strong>&#8220;ya\u015fl\u0131l\u0131kta k\u0131r\u0131k spektrumu&#8221;<\/strong>&nbsp;kavram\u0131n\u0131 mercek alt\u0131na alacak; k\u0131r\u0131lganl\u0131k, osteoporoz ve frakt\u00fcr aras\u0131ndaki patofizyolojik ba\u011f\u0131 inceleyecek ve acil servis y\u00f6netimindeki kritik farkl\u0131l\u0131klar\u0131 ele alaca\u011f\u0131z.<\/p>\n\n\n\n<p><strong>Patofizyolojik Zemin: K\u0131r\u0131lgan Kemikler, K\u0131r\u0131lgan Bedenler<\/strong><\/p>\n\n\n\n<p>Ya\u015flanmayla birlikte kemik mineral yo\u011funlu\u011fu azal\u0131r, trabek\u00fcler yap\u0131 incelir ve kortikal kemik daha g\u00f6zenekli hale gelir. Bu durum,\u00a0osteoporoz\u00a0olarak tan\u0131mlan\u0131r ve d\u00fc\u015f\u00fck enerjili travmalarla bile k\u0131r\u0131k olu\u015fma riskini belirgin \u015fekilde art\u0131r\u0131r. Bunun yan\u0131nda\u00a0sarkopeni, yani ya\u015fa ba\u011fl\u0131 kas k\u00fctlesi ve kas g\u00fcc\u00fc kayb\u0131, d\u00fc\u015fme riskini y\u00fckselten en \u00f6nemli fakt\u00f6rlerden biridir. Kas g\u00fcc\u00fcn\u00fcn azalmas\u0131, denge kontrol\u00fcn\u00fc zay\u0131flat\u0131r ve refleks yan\u0131tlar\u0131n yava\u015flamas\u0131na neden olur. B\u00f6ylece ya\u015fl\u0131 birey, d\u00fc\u015fme an\u0131nda v\u00fccudunu koruyacak tepkiyi veremez ve k\u0131r\u0131k olu\u015fma olas\u0131l\u0131\u011f\u0131 artar.<\/p>\n\n\n\n<p>Ya\u015fl\u0131 bireylerde k\u0131r\u0131k geli\u015fimine zemin haz\u0131rlayan fizyolojik de\u011fi\u015fiklikler, yaln\u0131zca kemik yap\u0131s\u0131ndaki bozulmalarla s\u0131n\u0131rl\u0131 de\u011fildir; kas-iskelet sistemi, sinir sistemi, denge mekanizmalar\u0131 ve ila\u00e7 metabolizmas\u0131 gibi pek \u00e7ok sistemin b\u00fct\u00fcnc\u00fcl etkisi s\u00f6z konusudur. Bu nedenle ya\u015fl\u0131 bir hastada basit g\u00f6r\u00fcnen bir d\u00fc\u015fme, asl\u0131nda uzun s\u00fcredir devam eden biyolojik k\u0131r\u0131lganl\u0131\u011f\u0131n klinik bir yans\u0131mas\u0131d\u0131r.<\/p>\n\n\n\n<p><strong>Postural instabilite<\/strong>&nbsp;(denge bozuklu\u011fu) ya\u015flanmayla s\u0131k g\u00f6r\u00fclen bir di\u011fer sorundur. Vestib\u00fcler sistemdeki ya\u015fa ba\u011fl\u0131 dejenerasyon, propriyoseptif duyunun azalmas\u0131 ve g\u00f6rme keskinli\u011finin d\u00fc\u015fmesi, \u00f6zellikle karanl\u0131k veya kaygan ortamlarda d\u00fc\u015fme riskini katlar. Buna ek olarak, \u00e7oklu ila\u00e7 kullan\u0131m\u0131 (polifarmasi) da \u00f6nemli bir risk fakt\u00f6r\u00fcd\u00fcr. Antihipertansifler, benzodiazepinler, antidepresanlar ve hipoglisemik ila\u00e7lar ba\u015f d\u00f6nmesi, ortostatik hipotansiyon veya dengesizlik yaratarak d\u00fc\u015fmeye zemin haz\u0131rlayabilir.<\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalarda metabolik h\u0131z\u0131n yava\u015flamas\u0131, karaci\u011fer ve b\u00f6brek fonksiyonlar\u0131ndaki gerileme, ila\u00e7lar\u0131n farmakokineti\u011fini de\u011fi\u015ftirir. Bu durum, \u00f6zellikle a\u011fr\u0131 kesiciler, sedatifler ve antikoag\u00fclanlar a\u00e7\u0131s\u0131ndan hem d\u00fc\u015fme riskini hem de travma sonras\u0131 komplikasyon olas\u0131l\u0131\u011f\u0131n\u0131 art\u0131r\u0131r. Ayr\u0131ca, kronik hastal\u0131klar (\u00f6rne\u011fin kalp yetmezli\u011fi, diyabet, kronik b\u00f6brek hastal\u0131\u011f\u0131) v\u00fccudun travmaya verdi\u011fi yan\u0131t\u0131 s\u0131n\u0131rlar, iyile\u015fmeyi geciktirir ve posttravmatik mortaliteyi y\u00fckseltir.<\/p>\n\n\n\n<p>Ya\u015fl\u0131 bireylerde k\u0131r\u0131k geli\u015fimi \u00e7o\u011fu zaman tek bir etkenin sonucu de\u011fildir. Osteoporoz, sarkopeni, dengesizlik, g\u00f6rme bozuklu\u011fu ve polifarmasi gibi fakt\u00f6rlerin birbirini tetikledi\u011fi\u00a0multifakt\u00f6riyel bir s\u00fcre\u00e7\u00a0s\u00f6z konusudur ve bu s\u00fcre\u00e7 ya\u015fl\u0131 hastalardaki k\u0131r\u0131k spektrumunun farkl\u0131la\u015fmas\u0131na neden olur. Bu nedenle acil serviste ya\u015fl\u0131 bir hastadan \u201ck\u00fc\u00e7\u00fck bir d\u00fc\u015fme\u201d \u00f6yk\u00fcs\u00fc al\u0131nd\u0131\u011f\u0131nda, bu ifadenin arkas\u0131nda ciddi bir biyolojik k\u0131r\u0131lganl\u0131k olabilece\u011fi unutulmamal\u0131 ve de\u011ferlendirme kapsaml\u0131 bir bak\u0131\u015f a\u00e7\u0131s\u0131yla yap\u0131lmal\u0131d\u0131r.<\/p>\n\n\n\n<p><strong>Travma Mekanizmalar\u0131:&nbsp;<\/strong><strong>Basit D\u00fc\u015fmelerin Karma\u015f\u0131k Sonu\u00e7lar\u0131<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 bireylerde travma mekanizmalar\u0131 gen\u00e7 eri\u015fkinlerden belirgin bi\u00e7imde farkl\u0131d\u0131r. Gen\u00e7lerde k\u0131r\u0131klar \u00e7o\u011funlukla y\u00fcksek enerjili olaylar\u2014trafik kazalar\u0131, y\u00fcksekten d\u00fc\u015fmeler veya end\u00fcstriyel yaralanmalar\u2014sonucu ortaya \u00e7\u0131karken, ya\u015fl\u0131larda k\u0131r\u0131klar\u0131n b\u00fcy\u00fck b\u00f6l\u00fcm\u00fc d\u00fc\u015f\u00fck enerjili travmalarla geli\u015fir. En tipik \u00f6rnek, ev i\u00e7inde meydana gelen\u00a0basit d\u00fc\u015fmelerdir. Hal\u0131ya tak\u0131lma, banyo zemininin kayganl\u0131\u011f\u0131 veya ani ba\u015f d\u00f6nmesi gibi k\u00fc\u00e7\u00fck olaylar, osteoporotik kemik yap\u0131s\u0131 ve azalm\u0131\u015f kas g\u00fcc\u00fc nedeniyle ciddi k\u0131r\u0131klara yol a\u00e7abilir.<\/p>\n\n\n\n<p>Bu ya\u015f grubunda g\u00f6r\u00fclen d\u00fc\u015fmeler genellikle\u00a0mekanik dengesizlik\u00a0ve\u00a0fizyolojik zay\u0131fl\u0131k\u00a0ile ili\u015fkilidir. G\u00f6rme bozukluklar\u0131, i\u015fitme kayb\u0131, propriyosepsiyon azalmas\u0131 ve vestib\u00fcler sistemdeki ya\u015fa ba\u011fl\u0131 de\u011fi\u015fiklikler denge kontrol\u00fcn\u00fc olumsuz etkiler. Ayr\u0131ca polifarmasiye ba\u011fl\u0131 ortostatik hipotansiyon, hipoglisemi ataklar\u0131 veya sedatif ila\u00e7 kullan\u0131m\u0131 yine d\u00fc\u015fme riskini art\u0131r\u0131r. Bu nedenle travma sonras\u0131 yaralanman\u0131n ciddiyetinde travman\u0131n mekanik \u015fiddetinden \u00e7ok, hastan\u0131n\u00a0biyolojik k\u0131r\u0131lganl\u0131\u011f\u0131 belirleyici olur.<\/p>\n\n\n\n<p>D\u00fc\u015fme d\u0131\u015f\u0131nda daha az s\u0131kl\u0131kla\u00a0d\u00fc\u015f\u00fck h\u0131zl\u0131 ara\u00e7 i\u00e7i kazalar,\u00a0merdivenden inme s\u0131ras\u0131nda dengesizlik,\u00a0sandalyeden kalkarken d\u00fc\u015fme\u00a0veya\u00a0ba\u015fkas\u0131n\u0131n yard\u0131m\u0131yla y\u00fcr\u00fcrken devrilme\u00a0gibi mekanizmalar da ya\u015fl\u0131larda ciddi yaralanmalara neden olabilir. \u00d6zellikle femur boynu, pelvis, vertebra ve distal radius k\u0131r\u0131klar\u0131 bu t\u00fcr travmalarla s\u0131k ili\u015fkilidir.<\/p>\n\n\n\n<p>Baz\u0131 olgularda travma hik\u00e2yesi bile belirsiz olabilir. Hafif bir \u00e7arpma, ani bir d\u00f6nme hareketi veya \u00f6ks\u00fcr\u00fck s\u0131ras\u0131nda bile osteoporotik vertebra veya kaburga k\u0131r\u0131klar\u0131 geli\u015febilir. Bu nedenle acil servis de\u011ferlendirmesinde hastan\u0131n\u00a0\u201cd\u00fc\u015fme hat\u0131rlam\u0131yorum\u201d\u00a0demesi, travmay\u0131 d\u0131\u015flamak i\u00e7in yeterli de\u011fildir. A\u011fr\u0131n\u0131n yeri, hareketle ili\u015fkisi, deformite ve fonksiyon kayb\u0131 gibi ipu\u00e7lar\u0131 dikkatle sorgulanmal\u0131d\u0131r.<\/p>\n\n\n\n<p>Ek olarak, ya\u015fl\u0131larda g\u00f6r\u00fclen travmalar\u0131n bir k\u0131sm\u0131\u00a0senkop, aritmi, inme veya hipoglisemi\u00a0gibi altta yatan bir medikal olay\u0131n sonucu olabilir. Bu durumda travma, primer patolojinin sekonder bir bulgusu haline gelir. Dolay\u0131s\u0131yla acil serviste yaln\u0131zca k\u0131r\u0131\u011f\u0131 saptamak yeterli olmay\u0131p, d\u00fc\u015fmeye yol a\u00e7an neden de ara\u015ft\u0131r\u0131lmal\u0131d\u0131r. Bu yakla\u015f\u0131m hem tekrarlayan d\u00fc\u015fmeleri \u00f6nlemek hem de mortaliteyi azaltmak a\u00e7\u0131s\u0131ndan kritik \u00f6neme sahiptir.<\/p>\n\n\n\n<p>Ya\u015fl\u0131larda travma, fiziksel enerjiden ziyade biyolojik zay\u0131fl\u0131\u011f\u0131n bir g\u00f6stergesidir. Bu nedenle acil serviste d\u00fc\u015f\u00fck enerjili travmalar\u0131n\u00a0ciddi yaralanma potansiyeline sahip oldu\u011fu\u00a0unutulmamal\u0131 ve her ya\u015fl\u0131 travma hastas\u0131, sistematik bir de\u011ferlendirmeyle ele al\u0131nmal\u0131d\u0131r.<\/p>\n\n\n\n<p><strong>K\u0131r\u0131k Spektrumu: En S\u0131k G\u00f6r\u00fclen K\u0131r\u0131k Tipleri<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 bireylerde g\u00f6r\u00fclen k\u0131r\u0131klar\u0131n da\u011f\u0131l\u0131m\u0131, travma enerjisinden \u00e7ok biyolojik k\u0131r\u0131lganl\u0131k d\u00fczeyine ba\u011fl\u0131 olarak de\u011fi\u015fir. Bu grupta en s\u0131k kar\u015f\u0131la\u015f\u0131lan k\u0131r\u0131klar; kal\u00e7a, vertebra, distal radius, proksimal humerus ve pelvis b\u00f6lgelerinde g\u00f6r\u00fcl\u00fcr. Her biri farkl\u0131 klinik tabloyla seyreder ve acil servis yakla\u015f\u0131m\u0131 a\u00e7\u0131s\u0131ndan \u00f6zel dikkat gerektirir.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Kal\u00e7a ve Femur K\u0131r\u0131klar\u0131<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Kal\u00e7a k\u0131r\u0131klar\u0131, ya\u015fl\u0131 travmalar\u0131n\u0131n en ciddi ve en mortal seyirli grubunu olu\u015fturur. \u00c7o\u011fu olgu, basit bir d\u00fc\u015fme sonras\u0131 geli\u015fir ve genellikle\u00a0femur boynu<strong>\u00a0<\/strong>veya\u00a0intertrokanterik b\u00f6lge\u00a0k\u0131r\u0131\u011f\u0131 \u015feklindedir. Hastalar s\u0131kl\u0131kla etkilenen ekstremitede k\u0131salma, d\u0131\u015f rotasyon deformitesi ve belirgin a\u011fr\u0131 ile ba\u015fvurur. Ancak baz\u0131 k\u0131r\u0131klar radyografide ba\u015flang\u0131\u00e7ta fark edilmeyebilir; bu nedenle klinik \u015f\u00fcphe varsa BT veya MRG ile ileri de\u011ferlendirme yap\u0131lmal\u0131d\u0131r. Bu k\u0131r\u0131klar, erken d\u00f6nemde analjezi, s\u0131v\u0131 deste\u011fi ve antikoag\u00fclasyon d\u00fczenlemesi gerektirir. Morbidite, uzun s\u00fcreli immobilizasyon ve komplikasyon riski y\u00fcksek oldu\u011fundan ortopedik kons\u00fcltasyon geciktirilmemelidir.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Vertebra Kompresyon K\u0131r\u0131klar\u0131<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Vertebral k\u0131r\u0131klar \u00e7o\u011fu zaman\u00a0d\u00fc\u015f\u00fck enerjili travma\u00a0veya hatta \u00f6ks\u00fcr\u00fck, ani d\u00f6nme gibi minimal hareketlerle bile geli\u015febilir. \u00d6zellikle torakolomber b\u00f6lgede s\u0131k g\u00f6r\u00fcl\u00fcr. Bel ve s\u0131rt a\u011fr\u0131s\u0131, hareketle artan hassasiyet veya boy k\u0131salmas\u0131 tipik bulgulard\u0131r. Ancak bu hastalar s\u0131kl\u0131kla a\u011fr\u0131lar\u0131n\u0131 \u201ckas tutulmas\u0131\u201d olarak yorumlay\u0131p ge\u00e7 ba\u015fvurabilir. Tan\u0131da lateral omurga grafileri de\u011ferlidir, ancak osteoporotik zeminde radyolojik bulgular silik olabilece\u011finden MRG gerekebilir. Analjezi ve mobilizasyon planlamas\u0131 yap\u0131l\u0131rken opioid duyarl\u0131l\u0131\u011f\u0131, deliryum riski ve kab\u0131zl\u0131k gibi geriatrik fakt\u00f6rler mutlaka g\u00f6z \u00f6n\u00fcnde bulundurulmal\u0131d\u0131r.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Distal Radius (Colles) K\u0131r\u0131klar\u0131<\/strong><\/li>\n<\/ul>\n\n\n\n<p>D\u00fc\u015ferken elini yere koyan ya\u015fl\u0131 bireylerde\u00a0ekstansiyon pozisyonunda d\u00fc\u015fme\u00a0sonras\u0131 tipik olarak distal radius k\u0131r\u0131\u011f\u0131 geli\u015fir. \u201cDinner fork\u201d deformitesi klasik g\u00f6r\u00fcn\u00fcm\u00fc olu\u015fturur. Bu k\u0131r\u0131klar \u00e7o\u011fu zaman basit atel uygulamas\u0131yla stabilize edilebilse de, osteoporotik kemik yap\u0131s\u0131 red\u00fcksiyon sonras\u0131 tekrar kaymaya yatk\u0131nd\u0131r. N\u00f6rovask\u00fcler b\u00fct\u00fcnl\u00fck kontrol\u00fc, uygun immobilizasyon ve a\u011fr\u0131 kontrol\u00fc acil servisteki temel yakla\u015f\u0131mlard\u0131r.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Proksimal Humerus K\u0131r\u0131klar\u0131<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Omuz \u00fczerine d\u00fc\u015fme veya kolun \u00fczerine y\u00fck binmesiyle ortaya \u00e7\u0131kar. A\u011fr\u0131 ve omuz hareketlerinde belirgin k\u0131s\u0131tl\u0131l\u0131k tipiktir. \u00c7o\u011fu olguda cerrahi d\u0131\u015f\u0131 tedavi yeterlidir, ancak yer de\u011fi\u015ftirmi\u015f k\u0131r\u0131klarda ortopedik de\u011ferlendirme gerekir. Ya\u015fl\u0131larda bu k\u0131r\u0131klar fonksiyonel ba\u011f\u0131ms\u0131zl\u0131\u011f\u0131 ciddi \u015fekilde k\u0131s\u0131tlayabilir, bu nedenle erken fizyoterapi planlamas\u0131 \u00f6nem ta\u015f\u0131r.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Pelvik K\u0131r\u0131klar<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Pelvis k\u0131r\u0131klar\u0131 ya\u015fl\u0131larda genellikle\u00a0d\u00fc\u015f\u00fck enerjili travmalar\u00a0sonras\u0131 olu\u015fur, ancak y\u00fcksek mortaliteye sahip olabilir. \u00d6zellikle pubik ramus k\u0131r\u0131klar\u0131 \u00e7o\u011fu zaman stabil olsa da, sakral veya asetabular bile\u015fen i\u00e7eren k\u0131r\u0131klar ileri ya\u015fta ciddi kan kayb\u0131na yol a\u00e7abilir. Pelvik a\u011fr\u0131, oturamama, y\u00fcr\u00fcyememe veya pelvik stabilitede bozulma gibi bulgular dikkatle de\u011ferlendirilmelidir. Ya\u015fl\u0131 hastalarda intraabdominal kanama belirtileri silik olabilece\u011finden, vital bulgular\u0131n yak\u0131ndan izlenmesi gerekir.<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Di\u011fer K\u0131r\u0131klar<\/strong><\/li>\n<\/ul>\n\n\n\n<p>Kosta, patella ve ayak bile\u011fi k\u0131r\u0131klar\u0131 da ya\u015fl\u0131 pop\u00fclasyonda s\u0131k g\u00f6r\u00fcl\u00fcr. \u00d6zellikle kaburga k\u0131r\u0131klar\u0131 solunum fonksiyonlar\u0131n\u0131 olumsuz etkileyerek atelektazi ve pn\u00f6moni riskini art\u0131r\u0131r. Bu nedenle uygun analjezi ve solunum egzersizleri hayati \u00f6nemdedir.<\/p>\n\n\n\n<p><strong>Acil Serviste Tan\u0131sal Zorluklar<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 bireylerde k\u0131r\u0131k tan\u0131s\u0131, gen\u00e7 hastalara k\u0131yasla \u00e7ok daha fazla klinik dikkat, sab\u0131r ve deneyim gerektirir. Bunun ba\u015fl\u0131ca nedeni, travma enerjisinin d\u00fc\u015f\u00fck olmas\u0131, klinik bulgular\u0131n silik seyretmesi ve e\u015flik eden bili\u015fsel veya duyusal bozukluklard\u0131r. Bu fakt\u00f6rlerin birle\u015fimi, acil serviste k\u0131r\u0131klar\u0131n s\u0131kl\u0131kla g\u00f6zden ka\u00e7mas\u0131na zemin haz\u0131rlar.<\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalar travma sonras\u0131 \u00e7o\u011fu zaman\u00a0belirsiz veya atipik semptomlarla\u00a0ba\u015fvururlar. A\u011fr\u0131 hissi ya\u015fla birlikte azal\u0131r, ayr\u0131ca demans, deliryum veya n\u00f6ropati gibi durumlar a\u011fr\u0131n\u0131n do\u011fru ifade edilmesini engeller. Bu nedenle \u201chafif a\u011fr\u0131m var\u201d diyen bir ya\u015fl\u0131 hasta, ciddi bir kal\u00e7a veya pelvis k\u0131r\u0131\u011f\u0131na sahip olabilir. Benzer \u015fekilde, d\u00fc\u015fme \u00f6yk\u00fcs\u00fc olmayan veya hat\u0131rlanmayan hastalarda bile spontan vertebra k\u0131r\u0131klar\u0131 g\u00f6r\u00fclebilir. Bu nedenle her a\u011fr\u0131 yak\u0131nmas\u0131, \u00f6zellikle y\u00fck verme g\u00fc\u00e7l\u00fc\u011f\u00fc veya hareket k\u0131s\u0131tl\u0131l\u0131\u011f\u0131 e\u015flik ediyorsa, travma \u00f6yk\u00fcs\u00fc olmasa dahi k\u0131r\u0131k a\u00e7\u0131s\u0131ndan de\u011ferlendirilmelidir.<\/p>\n\n\n\n<p><strong>Fizik muayene<\/strong>&nbsp;acil servisteki en \u00f6nemli arac\u0131m\u0131z olsa da bu ya\u015f grubunda \u00e7o\u011fu zaman yan\u0131lt\u0131c\u0131d\u0131r. Ya\u015fl\u0131 hastalarda kas dokusunun zay\u0131fl\u0131\u011f\u0131, cilt alt\u0131 ya\u011f tabakas\u0131n\u0131n incelmesi ve deformite olu\u015fumunun azalmas\u0131 nedeniyle belirgin d\u0131\u015f bulgular g\u00f6r\u00fclmeyebilir. \u00d6dem veya ekimoz ge\u00e7 ortaya \u00e7\u0131kabilir ya da hi\u00e7 geli\u015fmeyebilir. Ayr\u0131ca ya\u015fl\u0131 hastalar a\u011fr\u0131y\u0131 azaltmak i\u00e7in istemsiz olarak etkilenen b\u00f6lgeyi kullanmamay\u0131 tercih ederler, bu da klinik bulgular\u0131n saptanmas\u0131n\u0131 zorla\u015ft\u0131r\u0131r. Bu nedenle muayene sistematik yap\u0131lmal\u0131, yaln\u0131zca a\u011fr\u0131 b\u00f6lgesi de\u011fil, kom\u015fu eklemler ve omurga da dikkatle incelenmelidir.<\/p>\n\n\n\n<p><strong>Radyolojik de\u011ferlendirme<\/strong>&nbsp;de ya\u015fl\u0131larda \u00f6zel dikkat gerektirir. Osteoporotik kemik dokusu, k\u0131r\u0131k hatt\u0131n\u0131n radyografide net se\u00e7ilememesine neden olabilir. Bu nedenle \u00f6zellikle kal\u00e7a, pelvis ve vertebra b\u00f6lgelerinde ilk grafilerin normal olmas\u0131 k\u0131r\u0131\u011f\u0131 d\u0131\u015flatmaz. Klinik \u015f\u00fcphe devam ediyorsa, ileri g\u00f6r\u00fcnt\u00fcleme y\u00f6ntemleri tercih edilmelidir. MRG, erken d\u00f6nemde kemik ili\u011fi \u00f6demi ve mikrotrabek\u00fcler hasar\u0131 g\u00f6sterebildi\u011fi i\u00e7in bu grupta alt\u0131n standart y\u00f6ntemlerden biridir. BT ise k\u00fc\u00e7\u00fck kortikal k\u0131r\u0131klar\u0131 saptamada yararl\u0131d\u0131r ve \u00f6zellikle pelvis veya proksimal femur k\u0131r\u0131klar\u0131n\u0131n de\u011ferlendirilmesinde tercih edilir.<\/p>\n\n\n\n<p><strong>Acil servis dinamikleri<\/strong>, tan\u0131sal zorluklar\u0131 daha da art\u0131rabilir. Y\u00fcksek hasta yo\u011funlu\u011fu, k\u0131s\u0131tl\u0131 zaman ve ileri g\u00f6r\u00fcnt\u00fcleme eri\u015fiminin gecikmesi, ya\u015fl\u0131 k\u0131r\u0131klar\u0131n\u0131n tan\u0131s\u0131nda gecikmelere yol a\u00e7abilir. Bu nedenle ya\u015fl\u0131 travma hastalar\u0131nda\u00a0d\u00fc\u015f\u00fck \u015f\u00fcphe e\u015fi\u011fi\u00a0ile hareket edilmesi, tan\u0131 s\u00fcrecinin en temel prensibidir. \u201cBasit d\u00fc\u015fme\u201d veya \u201cevde aya\u011f\u0131 kaym\u0131\u015f\u201d gibi \u00f6yk\u00fcler, \u00e7o\u011fu zaman ciddi k\u0131r\u0131klar\u0131n alt\u0131nda yatan hik\u00e2yedir.<\/p>\n\n\n\n<p>Acil serviste, ya\u015fl\u0131 hastan\u0131n yaln\u0131zca travma b\u00f6lgesine de\u011fil, genel durumuna da b\u00fct\u00fcnc\u00fcl bakmal\u0131d\u0131r. K\u0131r\u0131\u011f\u0131n yan\u0131 s\u0131ra travmay\u0131 tetikleyen nedenin\u2014\u00f6rne\u011fin senkop, aritmi, inme veya hipoglisemi\u2014ara\u015ft\u0131r\u0131lmas\u0131, olas\u0131 tekrar eden d\u00fc\u015fmelerin \u00f6nlenmesi a\u00e7\u0131s\u0131ndan b\u00fcy\u00fck \u00f6nem ta\u015f\u0131r. Ya\u015fl\u0131 hastalarda travma de\u011ferlendirmesi, yaln\u0131zca bir kemik lezyonunu saptamak de\u011fil,\u00a0b\u00fct\u00fcnc\u00fcl bir geriatrik travma yakla\u015f\u0131m\u0131n\u0131\u00a0gerektirir.<\/p>\n\n\n\n<p><strong>Erken Mobilizasyon, Rehabilitasyon ve Taburculuk Plan\u0131<\/strong><\/p>\n\n\n\n<p>Ya\u015fl\u0131 hastalarda k\u0131r\u0131k y\u00f6netimi yaln\u0131zca akut d\u00f6nemde yap\u0131lan tan\u0131 ve stabilizasyonla s\u0131n\u0131rl\u0131 de\u011fildir. Tedavi s\u00fcrecinin as\u0131l amac\u0131, hastan\u0131n m\u00fcmk\u00fcn olan en k\u0131sa s\u00fcrede fonksiyonel kapasitesini yeniden kazanmas\u0131n\u0131 ve ba\u011f\u0131ms\u0131z ya\u015fam\u0131na d\u00f6nebilmesini sa\u011flamakt\u0131r. Bu nedenle erken mobilizasyon ve rehabilitasyon planlamas\u0131, tedavinin ayr\u0131lmaz bir par\u00e7as\u0131 olmal\u0131d\u0131r.<\/p>\n\n\n\n<p><strong>\u0130mmobilizasyon<\/strong>, ya\u015fl\u0131 hastalarda gen\u00e7 bireylere g\u00f6re \u00e7ok daha k\u0131sa s\u00fcrede ciddi komplikasyonlara yol a\u00e7ar. Uzun s\u00fcre yatak istirahati, derin ven trombozu, pulmoner emboli, pn\u00f6moni, bas\u0131 yaralar\u0131 ve kas atrofisi gibi komplikasyonlara neden olur. Hareketsizlik ayn\u0131 zamanda bili\u015fsel bozulmay\u0131 h\u0131zland\u0131r\u0131r, deliryum ve depresyon riskini art\u0131r\u0131r. Bu nedenle, genel durumu stabil olan her hastada mobilizasyon m\u00fcmk\u00fcn olan en k\u0131sa s\u00fcrede ba\u015flat\u0131lmal\u0131d\u0131r. Yatakta ge\u00e7irilen s\u00fcre azalt\u0131lmal\u0131, g\u00fcnl\u00fck aktiviteler kademeli olarak art\u0131r\u0131lmal\u0131d\u0131r.<\/p>\n\n\n\n<p><strong>Operasyon<\/strong> gerektiren k\u0131r\u0131klar\u0131n y\u00f6netimi, bu s\u00fcrecin kritik bir a\u015famas\u0131d\u0131r. \u00d6zellikle kal\u00e7a, intertrokanterik femur, pelvis veya proksimal humerus k\u0131r\u0131klar\u0131 s\u0131kl\u0131kla cerrahi tedavi gerektirir. Bu hastalarda cerrahiye kadar ge\u00e7en s\u00fcre boyunca a\u011fr\u0131 kontrol\u00fc, s\u0131v\u0131-elektrolit dengesi, beslenme deste\u011fi ve antikoag\u00fclan kullan\u0131m\u0131 dikkatle y\u00f6netilmelidir. Operasyon karar\u0131 geciktirilmemeli; m\u00fcmk\u00fcnse 24\u201348 saat i\u00e7inde cerrahi planlanmal\u0131d\u0131r, \u00e7\u00fcnk\u00fc gecikme mortalite ve komplikasyon riskini art\u0131r\u0131r. Ameliyat sonras\u0131 d\u00f6nemde erken mobilizasyonun sa\u011flanmas\u0131, pulmoner komplikasyonlar\u0131 ve immobilizasyona ba\u011fl\u0131 mortaliteyi azalt\u0131r. Bu d\u00f6nemde multidisipliner ekip yakla\u015f\u0131m\u0131 (ortopedi, geriatri, anestezi, hem\u015firelik ve fizik tedavi) iyile\u015fme s\u00fcrecinin ba\u015far\u0131s\u0131 a\u00e7\u0131s\u0131ndan belirleyicidir.<\/p>\n\n\n\n<p><strong>Rehabilitasyon<\/strong>&nbsp;s\u00fcreci, hastan\u0131n ya\u015f\u0131na, k\u0131r\u0131k tipine, bili\u015fsel durumuna ve komorbid hastal\u0131klar\u0131na g\u00f6re bireyselle\u015ftirilmelidir. \u00d6rne\u011fin kal\u00e7a k\u0131r\u0131kl\u0131 bir hastada, ilk 24\u201348 saat i\u00e7inde yatak kenar\u0131nda oturma, ard\u0131ndan y\u00fcr\u00fcte\u00e7 yard\u0131m\u0131yla aya\u011fa kalkma planlanabilir. Uygun analjezi sa\u011flanmadan mobilizasyonun m\u00fcmk\u00fcn olamayaca\u011f\u0131 unutulmamal\u0131d\u0131r. Bu nedenle, a\u011fr\u0131 kontrol\u00fc tedavi s\u00fcrecinin \u00f6n ko\u015fuludur; gerekirse b\u00f6lgesel sinir bloklar\u0131 veya multimodal analjezik protokoller kullan\u0131labilir.<\/p>\n\n\n\n<p><strong>Taburculuk plan\u0131<\/strong>, hastaneden \u00e7\u0131k\u0131\u015f \u00f6ncesinde net olarak olu\u015fturulmal\u0131d\u0131r. Hastan\u0131n ev ortam\u0131, d\u00fc\u015fmeye neden olabilecek \u00e7evresel fakt\u00f6rler (kaygan zemin, yetersiz ayd\u0131nlatma, hal\u0131 kenarlar\u0131, e\u015fik y\u00fcksekli\u011fi) a\u00e7\u0131s\u0131ndan de\u011ferlendirilmelidir. Gerekiyorsa sosyal hizmet deste\u011fi sa\u011flanmal\u0131, yard\u0131mc\u0131 cihazlar (baston, y\u00fcr\u00fcte\u00e7, oturma deste\u011fi) temin edilmelidir. Ayr\u0131ca aile \u00fcyeleri, hastan\u0131n mobilizasyon ve g\u00fcnl\u00fck ya\u015fam aktivitelerinde nas\u0131l destek olabilecekleri konusunda bilgilendirilmelidir.<\/p>\n\n\n\n<p>Bunun yan\u0131nda, d\u00fc\u015fmeye zemin haz\u0131rlayan fakt\u00f6rlerin ortadan kald\u0131r\u0131lmas\u0131 rehabilitasyon kadar \u00f6nemlidir. G\u00f6rme bozukluklar\u0131n\u0131n d\u00fczeltilmesi, antihipertansif veya sedatif ila\u00e7lar\u0131n yeniden d\u00fczenlenmesi, D vitamini ve kalsiyum deste\u011fi verilmesi ve egzersiz \u00f6nerileri gelecekteki k\u0131r\u0131klar\u0131 \u00f6nleyici yakla\u015f\u0131mlar aras\u0131nda yer al\u0131r.\u00a0\u201cBir kez d\u00fc\u015fen ya\u015fl\u0131, yeniden d\u00fc\u015fmeye adayd\u0131r\u201d\u00a0ilkesi unutulmamal\u0131d\u0131r.<\/p>\n\n\n\n<p>Erken mobilizasyon, planl\u0131 rehabilitasyon ve cerrahi y\u00f6netim stratejileri, ya\u015fl\u0131 k\u0131r\u0131k hastalar\u0131nda ya\u015fam kalitesi, ba\u011f\u0131ms\u0131zl\u0131k ve hayatta kalma oranlar\u0131n\u0131 do\u011frudan etkiler. Acil servis hekimleri i\u00e7in bu s\u00fcre\u00e7, yaln\u0131zca ortopedik tedavinin bir devam\u0131 de\u011fil, hastan\u0131n\u00a0b\u00fct\u00fcnc\u00fcl iyile\u015fme s\u00fcreci i\u00e7in<strong>\u00a0<\/strong>en kritik basamaklar\u0131ndan biridir. Etkin bir taburculuk plan\u0131 ve disiplinler aras\u0131 i\u015f birli\u011fi, k\u0131r\u0131\u011f\u0131 yaln\u0131zca bir travma de\u011fil, yeniden kazan\u0131m s\u00fcrecinin ba\u015flang\u0131c\u0131 haline getirir.<\/p>\n\n\n\n<p><strong>Sonu\u00e7: Ya\u015fl\u0131 K\u0131r\u0131klar\u0131 Acil Servisin Yeni Epidemisi mi?<\/strong><\/p>\n\n\n\n<p>Toplumun ya\u015flanmas\u0131yla birlikte acil servislere ba\u015fvuran ileri ya\u015f hasta say\u0131s\u0131 her ge\u00e7en y\u0131l artmaktad\u0131r. Bu art\u0131\u015f, yaln\u0131zca kronik hastal\u0131k y\u00fck\u00fcn\u00fcn de\u011fil, ayn\u0131 zamanda travma kaynakl\u0131 ba\u015fvurular\u0131n da \u00f6nemli \u00f6l\u00e7\u00fcde y\u00fckselmesine yol a\u00e7m\u0131\u015ft\u0131r. G\u00fcn\u00fcm\u00fczde ya\u015fl\u0131 bireylerde g\u00f6r\u00fclen k\u0131r\u0131klar, \u00f6zellikle d\u00fc\u015f\u00fck enerjili travmalar sonucu geli\u015fen k\u0131r\u0131lganl\u0131k k\u0131r\u0131klar\u0131, acil servislerin en s\u0131k ve en karma\u015f\u0131k hasta gruplar\u0131ndan birini olu\u015fturmaktad\u0131r. Bu durum, bir\u00e7ok \u00fclkede \u201cgizli epidemilerden biri\u201d olarak tan\u0131mlanmakta ve ya\u015flanan n\u00fcfusun sa\u011fl\u0131k sistemleri \u00fczerindeki y\u00fck\u00fcn\u00fc derinle\u015ftirmektedir.<\/p>\n\n\n\n<p>Ya\u015fl\u0131larda k\u0131r\u0131klar\u0131n y\u00f6netimi, yaln\u0131zca ortopedik bir sorun de\u011fildir. Her k\u0131r\u0131k, biyolojik rezervleri s\u0131n\u0131rl\u0131, polifarmasiye maruz kalm\u0131\u015f, komorbiditesi y\u00fcksek bir bireyin ya\u015fam dengesini sarsar. Bu nedenle acil t\u0131p uzman\u0131, ya\u015fl\u0131 k\u0131r\u0131klar\u0131n\u0131 de\u011ferlendirirken yaln\u0131zca anatomik hasara de\u011fil,\u00a0fizyolojik kapasiteye, bili\u015fsel duruma ve sosyal destek d\u00fczeyine\u00a0de odaklanmal\u0131d\u0131r. Basit bir d\u00fc\u015fmenin ard\u0131nda, \u00e7ok boyutlu bir klinik k\u0131r\u0131lganl\u0131k ve sistemik risk yatar.<\/p>\n\n\n\n<p>Bu hasta grubunda erken tan\u0131, uygun a\u011fr\u0131 y\u00f6netimi, s\u0131v\u0131 ve hemodinamik denge sa\u011flanmas\u0131, komorbid hastal\u0131klar\u0131n yeniden de\u011ferlendirilmesi ve multidisipliner koordinasyon (ortopedi, geriatri, anestezi, fizik tedavi, sosyal hizmet) b\u00fcy\u00fck \u00f6nem ta\u015f\u0131r. Geciken tan\u0131 veya yetersiz mobilizasyon, yaln\u0131zca fonksiyonel kay\u0131plara de\u011fil, mortalite art\u0131\u015f\u0131na da neden olabilir. Bu nedenle ya\u015fl\u0131 k\u0131r\u0131klar\u0131n\u0131n acil servisteki y\u00f6netimi,<strong>\u00a0\u201cerken fark et, h\u0131zl\u0131 stabilize et, multidisipliner planla\u201d<\/strong>\u00a0ilkesiyle y\u00fcr\u00fct\u00fclmelidir.<\/p>\n\n\n\n<p>Sonu\u00e7 olarak, ya\u015fl\u0131larda k\u0131r\u0131klar giderek artan bir halk sa\u011fl\u0131\u011f\u0131 sorunu ve acil servislerin kar\u015f\u0131s\u0131ndaki en \u00f6nemli klinik sorunlardan biridir. Bu k\u0131r\u0131klar, sessiz bir epidemi gibi yay\u0131lmakta; d\u00fc\u015f\u00fck enerjili travmalar\u0131n ard\u0131nda y\u00fcksek mortalite ve uzun d\u00f6nem ba\u011f\u0131ml\u0131l\u0131k riski ta\u015f\u0131maktad\u0131r. Acil t\u0131p uzmanlar\u0131n\u0131n bu tabloya y\u00f6nelik fark\u0131ndal\u0131\u011f\u0131 art\u0131rmas\u0131 hem bireysel hasta sonu\u00e7lar\u0131n\u0131 hem de sa\u011fl\u0131k sisteminin s\u00fcrd\u00fcr\u00fclebilirli\u011fini olumlu y\u00f6nde etkileyecektir.<\/p>\n\n\n\n<p><strong>Kaynaklar<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Court-Brown CM, Clement ND, Duckworth AD, Aitken S, Biant LC, McQueen MM. The spectrum of fractures in the elderly. Bone Joint J. 2014 Mar;96-B(3):366-72. doi: 10.1302\/0301-620X.96B3.33316. PMID: 24589793.<\/li>\n\n\n\n<li>Bingol I, Kamaci S, Yilmaz ET, Oral M, Yasar NE, Dumlupinar E, Ata N, Ulgu MM, Birinci S, Bayram S, Tokgozoglu AM, Demirors H. The epidemiology of geriatric fractures: A nationwide analysis of 1 million fractures. Injury. 2024 Nov;55(11):111900. doi: 10.1016\/j.injury.2024.111900. Epub 2024 Sep 19. PMID: 39332226.<\/li>\n\n\n\n<li>Khan AA, Slart RHJA, Ali DS, Bock O, Carey JJ, Camacho P, Engelke K, Erba PA, Harvey NC, Lems WF, Morgan S, Moseley KF, O&#8217;Brien C, Probyn L, Punda M, Richmond B, Schousboe JT, Shuhart C, Ward KA, Lewiecki EM; International Working Group on DXA Best Practices. Osteoporotic Fractures: Diagnosis, Evaluation, and Significance From the International Working Group on DXA Best Practices. Mayo Clin Proc. 2024 Jul;99(7):1127-1141. doi: 10.1016\/j.mayocp.2024.01.011. PMID: 38960497.<\/li>\n\n\n\n<li>Williams CT, Whyman J, Loewenthal J, Chahal K. Managing Geriatric Patients with Falls and Fractures. Orthop Clin North Am. 2023 Jul;54(3S):e1-e12. doi: 10.1016\/j.ocl.2023.04.001. Epub 2023 May 31. PMID: 37349065.<\/li>\n\n\n\n<li>Migliorini F, Giorgino R, Hildebrand F, et al. Fragility Fractures: Risk Factors and Management in the Elderly.\u00a0<em>Medicina (Kaunas)<\/em>. 2021;57(10):1119. Published 2021 Oct 17. doi:10.3390\/medicina57101119<\/li>\n\n\n\n<li>Stefko JM, Jaworski HM, Cush CT, Lyons JG. Trends and epidemiology of lower trunk fractures in the super elderly population in the United States from 2011 to 2020. Injury. 2024 Nov;55(11):111837. doi: 10.1016\/j.injury.2024.111837. Epub 2024 Aug 23. PMID: 39197325.<\/li>\n\n\n\n<li>Aguado HJ, Castill\u00f3n-Bernal P, Ventura-Wichner PS, Cervera-D\u00edaz MC, Abarca-Vegas J, Garc\u00eda-Fl\u00f3rez L, Salvador-Carre\u00f1o J, Garc\u00eda-Virto V, Sim\u00f3n-P\u00e9rez C, Ojeda-Thies C, S\u00e1ez-L\u00f3pez P, Gonz\u00e1lez-Montalvo JI; RNFC Working Group. Impact of subtrochanteric fractures in the geriatric population: better pre-fracture condition but poorer outcome than pertrochanteric fractures: evidence from the Spanish Hip Fracture Registry. J Orthop Traumatol. 2022 Mar 26;23(1):17. doi: 10.1186\/s10195-022-00637-8. PMID: 35347459; PMCID: PMC8960105.<\/li>\n\n\n\n<li>Schoeneberg C, Pass B, Oberkircher L, Rascher K, Knobe M, Neuerburg C, Lendemans S, Aigner R; Registry for Geriatric Trauma DGU. Impact of concomitant injuries in geriatric patients with proximal femur fracture : an analysis of the Registry for Geriatric Trauma. Bone Joint J. 2021 Sep;103-B(9):1526-1533. doi: 10.1302\/0301-620X.103B9.BJJ-2021-0358.R1. PMID: 34465160.<\/li>\n\n\n\n<li>Kucukler FK, Simsek Y, Turk A\u00c7, Arduc A, Guler S. Osteoporosis and Silent Vertebral Fractures in Nursing Home Resident Elderly Men in Turkey. J Clin Densitom. 2017 Apr-Jun;20(2):188-195. doi: 10.1016\/j.jocd.2015.05.064. Epub 2015 Jun 10. PMID: 26071170.<\/li>\n\n\n\n<li>Bergh, C., Wennergren, D., M\u00f6ller, M., &amp; Brisby, H. (2020). Fracture incidence in adults in relation to age and gender: a study of 27,169 fractures in the Swedish Fracture Register in a well-defined catchment area.\u00a0<em>PloS one<\/em>,\u00a0<em>15<\/em>(12), e0244291.<\/li>\n\n\n\n<li>Kanis JA, Oden A, Johnell O, Jonsson B, de Laet C, Dawson A. The burden of osteoporotic fractures: a method for setting intervention thresholds. Osteoporos Int. 2001;12(5):417-27. doi: 10.1007\/s001980170112. PMID: 11444092.<\/li>\n\n\n\n<li>Court-Brown CM, Clement ND, Duckworth AD, Biant LC, McQueen MM. The changing epidemiology of fall-related fractures in adults. Injury. 2017 Apr;48(4):819-824. doi: 10.1016\/j.injury.2017.02.021. Epub 2017 Mar 2. PMID: 28283181.<\/li>\n\n\n\n<li>Borgstr\u00f6m F, Karlsson L, Orts\u00e4ter G, Norton N, Halbout P, Cooper C, Lorentzon M, McCloskey EV, Harvey NC, Javaid MK, Kanis JA; International Osteoporosis Foundation. Fragility fractures in Europe: burden, management and opportunities. Arch Osteoporos. 2020 Apr 19;15(1):59. doi: 10.1007\/s11657-020-0706-y. PMID: 32306163; PMCID: PMC7166207.<\/li>\n\n\n\n<li>Rommens PM. Paradigm shift in geriatric fracture treatment. Eur J Trauma Emerg Surg. 2019 Apr;45(2):181-189. doi: 10.1007\/s00068-019-01080-x. Epub 2019 Feb 6. PMID: 30725152.<\/li>\n\n\n\n<li>Roth T, Kammerlander C, Gosch M, Luger TJ, Blauth M. Outcome in geriatric fracture patients and how it can be improved. Osteoporos Int. 2010 Dec;21(Suppl 4):S615-9. doi: 10.1007\/s00198-010-1401-4. Epub 2010 Nov 6. PMID: 21058001.<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>Yazar:&nbsp;\u00c7a\u011flar Kuas Edit\u00f6r:&nbsp;Canan Akman T\u00fcrkiye ve d\u00fcnya genelinde ya\u015fl\u0131 n\u00fcfusun h\u0131zla artmas\u0131, acil t\u0131p prati\u011fimizin odak noktas\u0131n\u0131 ka\u00e7\u0131n\u0131lmaz olarak de\u011fi\u015ftirmektedir. G\u00fcn\u00fcm\u00fcz acil&hellip;<\/p>\n","protected":false},"author":1185,"featured_media":735,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_acf_changed":false,"inline_featured_image":false,"_lmt_disableupdate":"","_lmt_disable":"","footnotes":""},"categories":[1,10014],"tags":[10020,10018,10064],"class_list":["post-733","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-genel","category-akademik-blog-yazisi","tag-acil-tip","tag-geriatri","tag-kirik"],"acf":[],"_links":{"self":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/733","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/users\/1185"}],"replies":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/comments?post=733"}],"version-history":[{"count":0,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/posts\/733\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media\/735"}],"wp:attachment":[{"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/media?parent=733"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/categories?post=733"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/tatd.org.tr\/geriatri\/wp-json\/wp\/v2\/tags?post=733"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}