老年伤害研究回顾

伤害是危害老年人群健康的一个重大的公共卫生问题。老年人由于自身生理、心理以及社会环境诸因素的共同作用,使其成为发生意外跌落、交通事故、自杀等伤害事件的高危人群,且其死亡率明显高于其它年龄组。伤害造成的后遗伤残不仅给老年人自身带来极大的痛苦和生活的不便,同时也给家庭和社会增加了沉重的精神和经济负担。然而,只要认真采取科学的方法,伤害是可以预防和控制的。     

福建省居民意外伤害死亡状况分析

[目的]了解我省城市、农村居民意外伤害死亡状况。[方法]利用福建省1986—2004年死因统计资料进行流行病学分析。[结果]我省城市居民意外伤害死亡率低于全国，农村高于全国，男性高于女性。前3位死因分别为道路交通运输事故、自杀和意外跌落。中青年群体是意外伤害的受害主体。[结论]伤害是社会安全和公共卫生问题，要采取切实可行的预防控制措施。     

中国人群2002年与伤害有关行为的分析

目的描述2002年中国人群与伤害有关行为，特别是与交通事故及自杀有关行为的流行水平，以及在不同教育水平、职业和地区人群中的分布。方法使用13个问题，利用2002年普查人口进行加权计算不同类别人群交通违章行为和保护性措施的执行情况，及家庭中农药、鼠药的保存情况。结果36．7％的人报告过去30天有在自行车道及机动车道上行走或乱穿马路的行为，其中3．67％为经常（〉3次／周），11．3％为有时（1～2次／周），21．7％为偶尔（1～2次／月）。30．3％骑自行车者报告过去30天有闯红灯、占用机动车道、骑车带人等违章行为。调查人群中有4351人过去30天有驾车经历，分别有13．2％、11．4％和16．9％的机动车驾驶员报告过去30天有酒后驾车、疲劳驾驶和无证驾驶的经历。驾驶员或乘车者经常佩带交通安全带的比例只有7．7％；目前驾驶和搭乘摩托车者中，经常戴头盔的比例为19．1％。男性交通违章的行为高于女性；农村人群交通违章的现象较城市严重。农村地区存放农药及鼠药的比例高于城市地区；。有10％的家庭随意放置农药或鼠药。结论中国人群的交通违章现象严重，且交通安全保护性措施（佩带安全带、摩托车头盔）执行力度不够。对农药、鼠药疏于管理，人群的安全防范意识差。     

自杀伤害及其预防

1990年以前,国内关于自杀预防的研究很少,自上世纪90年代开始,我国的自杀问题引起了国内外学的关注,并开始对自杀问题进行研究,同时对我国的自杀特征有了初步的认识。虽然有些国内外学认为自杀问题是我国重要的公共卫生问题,但还没有得到有关方面的广泛认同。联合国和世界卫生组织(WHO)强烈推荐其成员国制定国家级的自杀预防计划,以帮助协调和监督自杀预防工作。我国也正在制定适合中国具体情况的自杀预防计划。     

江西省1997、1998年意外伤害死亡分析

对江西省１９９７年、１９９８年疾病监测点的意外伤害死亡进行了分析。结果表明,伤害死亡的期望寿命寿年在年中均居首位,在伤害的死亡原因中农村以自杀为主要死因,城市以交通事故为主要死因,０－１４岁儿童,溺死是其中主要死因,因此,开展杀自,交通事故及溺死的预防工作十分必要。     

上海市崇明区2005—2014年老年人伤害死亡特征分析

【目的】分析上海市崇明区老年人伤害死亡的特征。【方法】对崇明区居民死因监测登记系统中的数据,采用DeathReg 2002和SPSS 16.0软件进行汇总和分析。【结果】2005—2014年崇明区60岁及以上老年人的伤害死亡率为148.45/10万,伤害为老年人死亡的第四位死因。男性老年人与女性老年人伤害死亡率差异无统计学意义(χ~2=0.905,P>0.05),死亡率随年龄增长而增高(χ■=29.923,P<0.05),意外跌落是老年人伤害死亡的首位死因,男性老年人首位死因为交通事故,女性老年人首位死因为意外跌落。【结论】伤害已经成为威胁崇明区老年人生命和健康的重要原因,应采取有效的预防措施预防和控制老年人伤害的发生。     

2006—2012年上海市闸北区居民伤害死亡分析

目的了解上海市闸北区伤害死亡变化趋势和特点,为进一步开展伤害预防和控制工作提供科学依据。方法采用描述性统计方法,对2006—2012年居民伤害死亡资料进行流行病学分析。结果 7年间,伤害死亡率呈波动下降趋势,从2006年的41.75/10万下降到2012年的28.64/10万,标化死亡率从2006年的20.47/10万下降到2012年的12.64/10万,下降了38.26%。男性标化伤害死亡率是女性的1.24倍。65岁以上老年人是伤害死亡的主要人群,占63.01%,而意外跌落又是老年人首位伤害死亡原因（死亡率为77.18/10万）,而交通事故是65岁以下人群的首位伤害死亡原因（死亡率为4.87/10万）。结论伤害日益成为一个严重的公共卫生问题,今后应有的放矢地开展伤害干预工作,加强对意外跌落和交通事故的宣教和指导。     

老年人口伤害特点及防范措施研究

目的分析大连市老龄人口伤害发生的分布特点及流行规律,为制定干预性措施提供依据。方法运用描述流行病学方法,将2006年1—12月在大连市3所3级甲等医院急诊室、其他门急诊及临床科室就诊后诊断为伤害的全部首诊病例作为监测对象并进行分析。结果全年3所医院共报告60岁以上老年伤害病例911例,男性390人,女性521人,男：女为0．75：1。前5位发生原因依次为跌倒／坠落（42．59％）、机动车车祸（24．04％）、钝器伤（13．28％）、刀／锐器伤（10．21％）、非机动车车祸（1．32％）;发生地点主要是家中（38．86％）、公路／街道（23．93％）、贸易和服务场所（24．82％）,公共居住场所（13．06％）、工业和建筑场所（2．41％）;伤害部位主要是头部（27．22％）、下肢（22．50％）、上肢（22．％％）、躯干（14．82％）;大多数伤害属于非故意伤害（86．39％）;57．19％的患者是轻度患者,治疗后可回家（69．59％）,死亡仅占0．22％。结论由于身体功能的衰退,老年人是各种伤害的高发人群,但所处环境相对较固定,活动范围较局限,因此伤害原因较集中,主要以跌倒／坠落和交通伤害为主,应强化针对性的防范措施。     

2011-2018年济宁市儿童青少年伤害死亡流行病学特征

目的 了解济宁市儿童青少年伤害死亡的变化情况及流行病学特征,为开展相关预防和干预工作提供科学依据.方法 利用死亡登记报告信息系统,汇总济宁市2011 2018年5～18岁儿童青少年伤害死亡信息,采用描述流行病学方法对死亡率、死因和死亡分布等特征进行分析.结果 2011-2018年济宁市儿童青少年伤害死亡1 107人,死亡率为10.40/10万,主要死因是交通事故,其次是淹溺和自杀,各年龄段伤害死因差别较大;男性死亡数约为女性的2.64倍;死亡季节多集中在夏季,淹溺死亡人数占夏季伤害死亡数的44.6％.结论 交通事故、淹溺和自杀是济宁市5～18岁儿童青少年主要伤害死因,应采取针对性干预措施.     

2013年浙江省台州市居民伤害死亡原因分析

[目的]了解2013年浙江省台州市居民伤害死亡原因及其分布特点,为伤害预防策略制定提供依据.[方法]对2013年浙江省台州市死亡监测数据采用“死亡医学登记系统(2005版)”(DeathReg 2005)和SPSS 13.0软件进行伤害死亡描述性统计分析. [结果] 2013年浙江省台州市伤害死亡率为63.91/10万,占死亡总数的11.05％,位居第5位.按潜在寿命损失年数(YPLL)进行排位,位居第2位.男性伤害死亡率为75.65/10万(标化死亡率73.44/10万),女性伤害死亡率为51.54/10万(标化死亡率48.43/10万).城市伤害死亡率为65.53/10万,农村为63.32/10万.伤害前5位死因依次为意外跌落、机动车辆交通事故、溺水、自杀、其他意外事故和有害效应.0～1岁组以窒息为主;1～14岁组以溺水为主,占该年龄段伤害死亡的43.05％;15～64岁组以交通事故为主,占该年龄段伤害死亡的33.14％;65～岁组以意外跌落为主,占该年龄段伤害死亡的49.48％. [结论]伤害是浙江省台州市居民的主要死亡原因之一,根据不同年龄阶段伤害死亡的流行特征,急需制定有效的控制策略,开展针对性的综合防制措施.     

The incidence of fall injury events among the elderly in a defined population

Falls are a leading cause of death from injury among older persons in the United States, and about one in three older persons falls each year. Yet, reliable estimates of the incidence of fall injury events in a population-based setting are not readily available. Therefore, the authors analyzed population-based surveillance data, between July 1985 and June 1987, from the Study to Assess Falls Among the Elderly, Miami Beach, Florida. The rate of fall injury events coming to acute medical attention increased exponentially with age for both elderly men and women (predominantly white), reaching a high for those aged 85 years or more of 138.5 per 1,000 for males and 158.8 per 1,000 for females. Compared with males, females had a higher incidence of fractures other than skull. Males were nearly twice as likely to die, however, following a fall injury event than were females. Of those fall injury events identified through the surveillance system, about 42% resulted in hospital admission. The mean length of hospital stay was 11.6 days overall and was 15.5 days for hip fracture, 9.8 days for skull fracture/intracranial injury, 11.2 days for all other fractures, and 9.1 days for all other injuries. About 50% of fall injury events that occurred at home and required hospital admission resulted in a person being discharged to a nursing home.     

2009—2010年浙江省老年人跌倒/坠落伤害流行病学特征分析

目的探讨浙江省60岁及以上老年人跌倒/坠落伤害流行病学特征,为施行科学有效的防制措施提供依据。方法通过网络报告的方式收集2009—2010年浙江省9个地区28家哨点医院的首诊老年跌倒/坠落伤害患者(≥60岁)的信息,分析老年患者伤害发生情况。结果共收集老年跌倒/坠落伤害监测病例8082例(男女性别比为0.87∶1);99.05%的伤害病例为意外伤害,伤害地点构成前3位为家中(65.13%)、公共场所(16.21%)、工作场所(10.86%)。48.08%的跌坠落伤是在"运动"时发生;伤害发生集中时段为9—11时与14—16时,秋冬季高于春夏季;老年人受伤部位前3位为下肢(36.65%)、上肢(27.06%)和头部(26.02%);受伤严重程度主要以轻到中度为主,严重伤害比例男性高于女性(χ2=10.335,P<0.01)结局以处理后回家为主(77.57%)。结论女性、户外运动、四肢伤害以及特定的环境因素与老年人的跌坠落伤有关,针对性的预防措施可能会有效减少老年人伤害的发生。     

Nutritional status in elderly population in kibbutzim

This study was conducted in order to assess the nutritional status of thiamin, riboflavin, pyridoxine, carotene, retinol, ascorbic acid, plasma iron, hemoglobin and plasma albumin of the elderly living in two cooperative farms (Kibbutzim), in Israel. Blood samples from elderly subjects aged 60 to 85 (33 women, 26 men), were collected for analysis. Thiamin, riboflavin and pyridoxine status were assessed by using enzymatic activation coefficient. Transketolase was used for determining thiamin status, glutathione reductase for determining riboflavin status and glutamate oxaloacetate transaminase for pyridoxine status. Transketolase activation coefficient ranged from 1.05-1.59 with a mean 1.18 and SEM 0.02, glutathione reductase coefficient ranged from 1.08-1.50 with a mean 1.25 and SEM 0.07 and glutamate oxaloacetate transaminase activation coefficient ranged from 1.71-2.15 with a mean 1.83 and SEM 0.06. Deficient levels were found in the following: Leucocyte ascorbic acid 5% of the population, hemoglobin 18%, plasma iron 20%, carotene 32% and plasma retinol 20%, thiamin 14% and riboflavin 32%. No deficient state was found in pyridoxine.     

Use of antiepileptic drugs in the elderly population

Medical records for 572 patients in two extended care facilities were reviewed to study seizure disorders and antiepileptic drug use. Seventy patients (12.2 percent) were receiving antiepileptic drugs. Of this group, 43 patients (61.4 percent) had a diagnosis of epilepsy or documented seizures, 2 were being treated for neuralgia, and 25 (35.7 percent) had no reason given for antiepileptic use. The most common cause was cerebrovascular accident (38.9 percent), and no associated etiology was found in 29.2 percent. Phenytoin was the most commonly used agent. Thirty-two (45.7 percent) were taking two or more antiepileptic drugs. Thirteen patients had had no serum concentration monitoring in the last year. Thirty-seven patients (52.9 percent) had had at least one serum concentration outside of the therapeutic range.     

Thermoregulatory responses of the elderly population

With a significant rise in the elderly population of the developed industrialized countries due to increased life span the harmful consequences of heat and cold stresses are expected to be more notable. Although effects of these harmful stresses on morbidity and mortality of the elder population are well documented in medical reports, relatively few studies are notable for the investigation of age-related effects on thermoregulation. In this report, data on responses of older individuals to heat stress during rest and exercise are summarized. When old men (60-86 years) were exposed to 40 degrees C and 40% relative humidity for 2 hr during rest, their total body sweat rate/m2 (SR) was similar to the young group (20-35 years). The onset of sweating was also similar in both groups. Regional SR was not uniform in either age group. Since the responses of both groups were similar, data were pooled to examine the relationship between age and physical fitness, as measured by aerobic capacity (VO2 max), to physiological responses. Only VO2 max and body fat were significantly related to age. The SR was related to fitness. When old men and women walked at a level costing 40% of their VO2 max in desert heat for 1 hr, total SR was similar in all age groups. The efficiency of walking was similar in young and old, but the least fit individuals were less efficient. In all our studies, the data clearly indicate that age per se does not decrease the functional capacity of the sweating mechanism and that problems encountered by the elderly in hot environments are primarily related to impairment of the cardiovascular functions.     

Prevalence of obesity in an elderly Hungarian population

Background: There are few cross-sectional population-based studies on obesity in Hungary. Aim of this study was to characterize the prevalence, associated diseases and metabolic laboratory parameters for obesity in men and women in Budapest, Hungary. Methods: A random sample of 641 persons (307 males and 334 females) aged 50 years and over were recruited from a population register in Budapest. Subjects were interviewed, had height and weight measured in standard fashion. Those who were obese (BMI > 30.0 kg/m²) were matched individually with non-obese subjects. Altogether 101 pairs (48 women and 53 men pairs) were taking part and these subjects had blood taken for amount of serum glucose, lipids and uric acid. Results: The mean age of men and women was 65.0 (SD = 9.1) years and 64.6 (SD = 8.9) years, respectively. The prevalence of obesity was 18.1% in men and 15.4% in women (p < 0.05). In both sexes the mean body mass index was higher at age of 50–64 years than at older ages [in men 27.2 (SD = 3.7) kg/m² vs. 26.7 (SD = 3.3) kg/m², p = 0.286 and in women 26.7 (SD = 4.2) kg/m² vs. 25.4 (SD = 4.0) kg/m², p = 0.005]. Body mass index was higher in men than in women at all ages. In the case–control study the mean age of obese and non-obese individuals were 63.1 (SD = 7.8) years and 63.2 (SD = 7.9) years, respectively. Obesity was significantly associated with a history of diabetes mellitus (18 vs. 7%, p < 0.05) and hypertension (48 vs. 28%, p < 0.05). Compared to the non-obese, those who were obese had a higher level of serum uric acid (311 ± 102 vs. 280 ± 96mol/l, p < 0.05) and triglyceride (2.67± 1.95 vs. 1.86 ± 0.95 mmol/l, p < 0.05). Conclusion: The high prevalence of obesity both in elderly men and women and its strong association with chronic diseases causes economical and social burden for Hungary. Strategies and programs for weight maintenance as well as weight reduction must become a higher public health priority.