帕金森病患者跌倒恐惧的多因素分析

目的研究帕金森病(Parkinson's disease,PD)患者跌倒恐惧(fear of falling,FOF)的影响因素。方法选择同济大学附属同济医院门诊就诊的PD患者115例,有跌倒史患者46例,无跌倒史患者69例。采用活动平衡信心(activities-specific balance confidence,ABC)评分评估患者FOF程度,采用Berg平衡量表(Berg balance scale,BBS)评定患者平衡功能,统一PD评定量表运动部分(unified Parkinson's disease rating scale-Ⅲ,UPDRS-Ⅲ)评定患者运动功能,统一PD评定量表姿势与步态部分(posture and gait subscores of the UPDRS,UPDRS-PG)评估患者姿势与步态损伤。用相关分析和逐步多元回归分析FOF的影响因素。结果有跌倒史与无跌倒史患者ABC评分比较,差异有统计学意义[(65.7±24.2)分vs(71.7±18.4)分,P0.05]。逐步多元回归分析显示,有≥2次跌倒史、UPDRS-PG和BBS评分是FOF的影响因素(P0.05,P0.01),UPDRS-Ⅲ评分不是FOF的影响因素(P0.05)。结论多次跌倒史、平衡功能障碍、姿势步态损伤是影响PD患者FOF的主要因素。     

认知行为干预对社区老年慢性病患者害怕跌倒的影响

目的探讨认知行为干预对社区老年慢性病患者害怕跌倒(FOF)的影响。方法将符合纳入标准的116例社区老年人作为研究对象,采用随机数字表法分为对照组和试验组各58例。对照组进行所患慢性病的常规护理;试验组在对照组的基础上给予认知行为干预,时间均为12 w。两组在干预前后分别进行跌倒自我效能、生存质量等观察指标的评价。结果干预后,试验组的跌倒自我效能评分和生存质量评分均高于干预前水平和对照组同期水平(P0.05)。结论认知行为干预可以提高社区老年慢性病患者跌倒自我效能和生存质量水平,可以改善其FOF程度。     

脑卒中患者跌倒恐惧的影响因素分析

目的研究脑卒中患者跌倒恐惧的影响因素。方法选择同济大学附属同济医院门诊就诊的脑卒中患者70例,采用活动平衡信心(activities-specific balance confidence,ABC)量表进行跌倒恐惧的评估,采用Berg平衡量表(Berg balance scale,BBS)、起立-行走计时试验(timed up and going test,TUGT)及Fugl-Meyer测评量表分别进行平衡功能、移动能力及下肢运动功能的评定。以所有患者ABC量表评分的中位数70分为标准,将有跌倒史的28例患者分为ABC高分组(≥70分)8例、ABC低分组(<70分)20例。应用多因素分析法评估年龄、性别、跌倒史、平衡功能、移动能力及下肢运动功能等因素对ABC量表评分的影响。结果所有因素中,年龄、跌倒史、平衡功能与移动能力比较,差异有统计学意义(P<0.05,P<0.01)。与ABC低分组比较,ABC高分组BBS评分明显升高,TUGT时间明显缩短,差异有统计学意义(P<0.05)。结论有跌倒史、平衡功能、移动能力和年龄是影响脑卒中患者跌倒恐惧的主要因素。     

老年骨质疏松患者害怕跌倒心理与生活质量的相关性

目的探讨老年骨质疏松(OP)患者害怕跌倒心理状况及其对生活质量的影响。方法采用修订版的跌倒效能量表(MFES)及简易健康状况调查问卷(SF-36)对94例老年OP患者(OP组)和97例健康老年人(对照组)进行问卷调查。结果 OP组跌倒效能得分低于对照组(P0.05),OP组的生活质量总得分及各维度得分与对照组比较差异显著,跌倒效能得分越高的老年OP患者其生活质量得分越高(P0.01)。结论老年人普遍存在害怕跌倒心理,且老年OP患者害怕跌倒心理更严重,一定程度影响了其生活质量,医务人员要重视害怕跌倒对老年OP患者的影响,并采取适当的干预措施。     

住院老年痴呆患者跌倒发生情况及危险因素分析

目的 调查住院老年痴呆患者跌倒情况并探讨跌倒的危险因素.方法 选取重庆医科大学附属第一医院老年科住院的121例老年痴呆患者为研究对象,调查其跌倒情况;并将研究对象按跌倒和未跌倒分为两组,分别给予简易智能状态量表( MMSE)、临床痴呆量表(CDR)、日常生活能力量表(ADL)、神经精神科问卷(NPI)及统一帕金森病量表(UPDRS)运动评分.以Logistic回归模型分析各种危险因素与跌倒之间的关系.结果 住院老年痴呆患者跌倒发生率为35.5％,NPI和UPDRS在跌倒组及未跌倒组中差异有统计学意义,Logistic回归分析显示精神行为异常、运动障碍和跌倒密切相关.结论 老年痴呆患者更易发生跌倒,运动障碍、精神行为异常是跌倒发生最为危险的因素,对这类人群应该采取一系列针对性的预防措施.     

内在能力下降对老年患者跌倒和再入院的影响

目的调查老年患者内在能力下降的情况, 并探讨内在能力下降对患者1年内跌倒和再入院的影响。方法纳入在浙江医院老年病科就诊的老年患者311例, 采集患者入院时一般情况资料及内在能力资料, 包括认知(简易智能精神状态检查量表)、运动(Tinetti-平衡量表和4 m试验)、活力(握力和微型营养评估简表)、感知(自评视力或听力下降)和社会心理(老年人抑郁量表), 并随访出院后1年内跌倒和再入院情况;多因素Logistic回归模型分析入院基线内在能力与1年内跌倒和再入院的关系。结果 311例老年住院患者存在内在能力下降282例(90.7%)。随访1年有38例老年患者(12.2%)发生跌倒、69例老年患者(22.2%)再次入院。在控制了年龄、性别、文化程度、共病、多重用药、害怕跌倒、跌倒史以及辅具使用等混杂因素影响后, Logistic回归分析结果显示, 平衡能力下降是老年患者1年内跌倒的危险因素(OR=3.515, 95%CI:1.089～11.346, P=0.036);步速减慢是患者1年内再入院的危险因素(OR=2.426, 95%CI:1.181～4.983, P=0.016)。结论运动能...     

基于智谋理论的健康教育在脑卒中偏瘫伴跌倒恐惧患者中的应用效果研究

目的 分析基于智谋理论的健康教育在脑卒中偏瘫伴跌倒恐惧（FOF）患者中的应用效果。方法选取广西中医药大学附属瑞康医院康复医学科2022年3—9月收治的脑卒中偏瘫伴FOF患者45例为常规组,2022年10月—2023年4月收治的脑卒中偏瘫伴FOF患者45例为智谋理论组。常规组患者接受常规健康教育和康复训练,智谋理论组患者在常规组的基础上接受基于智谋理论的健康教育,干预时间为8周。比较两组干预前、干预4周、干预8周修订版跌倒效能量表（MFES）评分,干预前及干预后智谋量表（RS）评分、中文版患者积极度量表（PAM）评分、改良Barthel指数（mBI）评分。结果 最终88例患者完成研究,其中常规组44例、智谋理论组44例。干预方法与时间在MFES评分上存在交互作用（P<0.05）;干预方法、时间在MFES评分上主效应显著（P<0.05）;智谋理论组干预4、8周MFES评分高于常规组（P<0.05）;常规组、智谋理论组干预4、8周MFES评分分别高于本组干预前,干预8周MFES评分分别高于本组干预4周（P<0.05）。智谋理论组干预后个人智谋、社会智谋维度得分及RS总...     

新疆社区老年退休警察害怕跌倒现况及影响因素

目的调查退休警察(社区人群)害怕跌倒现况;害怕跌倒与机体功能状态、社会人口学、健康相关因素的关系。方法采用横断面研究设计,纳入新疆乌鲁木齐市某行政单位60岁以上、社区居住的退休警察。问卷调查获得研究对象人口学资料及健康相关因素。采用跌倒功效量表(中文版,MFES)评价害怕跌倒现状。机体功能状态采用3种身体运动测试,平衡能力采用老年人平衡能力测试表评估;灵活性采用"起立-行走"计时测试(TUG);下肢肌肉力量采用座椅起坐测试(CRT)。利用线性相关系数及多元线性回归确定社区老年退休警察人群害怕跌倒的影响因素。结果研究共纳入研究对象309人,年龄60～89岁。MFES平均得分(7.63±2.48)分,得分随年龄段增长而降低,MFES与年龄、近1年有跌倒史、感到疼痛、同时患有老年慢性病、患有白内障呈负相关(P<0.001);与机体功能状态也呈负相关(P<0.001)。多元线性回归显示在控制年龄因素后,近1年跌倒史、CRT评分仍为社区老年退休警察人群害怕跌倒的独立影响因素(P<0.001)。结论曾发生过跌倒的老年警察更害怕跌倒。害怕跌倒心理状态与年龄、机体功能状态、社会人口学关系、健康相关因素有关,其中近1年是否有跌倒史、下肢力量强弱是社区老年退休警察人群害怕跌倒的独立影响因素。     

脑卒中患者跌倒恐惧干预方法研究进展

跌倒恐惧(FOF)在脑卒中患者中普遍存在,可导致患者回避行为,带来跌倒风险进一步增高,形成恶性循环。与健康老年人综合性干预方式不同,脑卒中患者FOF干预以改善特定功能和提高患者康复信心为目标。本研究基于近几年国外相关研究,总结分析不同措施的特点及效果,以帮助医护人员优化干预措施,改善脑卒中患者FOF恶性循环。     

老年痴呆患者跌倒危险因素的临床分析

目的 探讨老年痴呆患者跌倒的危险因素. 方法 选取北京老年医院118例(73.1±6.1)岁临床诊断痴呆患者,将入选病例按跌倒和未跌倒分为两组,即跌倒组、未跌倒组,给予患者行简易智能状态量表(MMSE)、临床痴呆量表(CDR)、日常生活能力量表(ADL)、神经精神科问卷(NPI)及统一帕金森病量表(UPDRS)运动评分并对数值进行对照研究.以logistic回归模型分析各种危险因素如体位性低血压、服用抗精神药物、服用镇静催眠药物、运动障碍及精神行为异常和跌倒之间的关系. 结果 NPI和UPDRS在跌倒组及未跌倒组中差异有统计学意义(t值分别为2.237和2.213,P均<0.05),单因素及多因素回归分析显示精神行为异常、运动障碍和跌倒有密切相关性(β=0.77和0.86,P均<0.05). 结论 在老年痴呆患者中运动障碍、精神行为异常和跌倒密切相关,为减少患者骨折及其他并发症,针对以上情况给予干预措施是十分必要的.     

Fear of falling in older women: a longitudinal study of incidence, persistence, and predictors

OBJECTIVES: To determine longitudinal predictors of incident and persistent fear of falling (FOF) in older women. DESIGN: Longitudinal study. SETTING: Clinical research center based at a university hospital. PARTICIPANTS: One thousand two hundred eighty-two community-dwelling women aged 70 to 85. MEASUREMENTS: FOF at baseline and after 3 years of follow-up; a range of baseline demographic and clinical variables, including mobility, balance, and depression. RESULTS: FOF was present in 418 subjects (33%) at baseline, developed in 30% of women who had been free of the symptom at baseline, and was reported by a total of 46% of the sample after 3 years of follow-up. In cross-sectional multivariable analysis, baseline FOF was independently associated with a range of variables, including living alone, obesity, cognitive impairment, depression, and impairments in balance and mobility. Baseline predictors of FOF that persisted after 3 years were similar, whereas obesity and slower timed up and go test scores predicted new-onset FOF. CONCLUSION: FOF in older women is a common and persistent complaint that is caused mainly by impairments of balance and mobility. A range of social, psychological, and physical risk factors for disability are associated with persistence of FOF. These results imply that early intervention may be important for the prevention of persistent FOF.     

Falls and fear of falling among older adults in an assisted-living facility: A qualitative and foundational study for intervention development in a developing country

BackgroundFalls and fear of falling (FOF) have serious adverse effects for older adults. Culturally-specific and environmentally-tailored interventions may help address the problems of falls and FOF. No such interventions are however available for use in the African context.ObjectiveTo explore falls and FOF among older adults in an assisted-living facility, as a foundation for developing interventions to address falls and FOF.MethodsThis qualitative study involved purposefully recruiting nine older adults and four caregivers at an assisted-living facility in Southeast Nigeria. Focus group discussions were conducted separately for older adults and the caregivers. Data were analysed using an Inductive Approach.ResultsFour themes emerged: incidence of falls and fear of falling; factors associated with falls and fear of falling; health implications of falls and fear of falling; and coping strategies to deal with falls and fear of falling. Older adults were experiencing a high prevalence of falls and FOF perceived to be caused by both cultural/environmental/institutional-related factors (poorly lit environment at night; poor ambulatory surfaces; unwillingness to accept age-related changes in physical capacity; poor disposition towards walking aids; poor treatment of injuries; misconceptions; poor physical activity participation; and external perturbation) and intrinsic factors (psychological/emotional, concentration/attention, socio-demographic and morbidity-related).ConclusionThe older adults were experiencing a high prevalence of falls and FOF which has a multifactorial origin of common and cultural/societal/institutional/environmental-related factors. The need for a multicomponent and culturally and environmentally-specific interventions to address falls and FOF in this sample is thus highlighted.     

Self-efficacy as a mediator between fear of falling and functional ability in the elderly

OBJECTIVES: This study examined falls self-efficacy and fear of falling to determine whether self-efficacy acts as a mediator between fear of falling and functional ability. METHODS. Using the Survey of Activities and Fear of Falling in the Elderly as a fear-of-falling measure and the Activities-Specific Balance Confidence Scale for falls self-efficacy, structural relationships among fear of falling, self-efficacy, functional balance, and physical functioning outcomes were tested with older adults (N = 256, M age = 77.5). RESULTS. Lower levels of fear of falling were significantly related to higher levels of falls self-efficacy, which was in turn associated with better functional outcomes. Moreover, falls self-efficacy mediated the effects of fear of falling on functional outcomes. DISCUSSION. Results substantiate the hypothesized mediational role of falls self-efficacy in fear of falling and underscore the need to consider ways of enhancing falls self-efficacy in interventions aimed at reducing falls and fear of falling.     

Transient versus persistent fear of falling in community-dwelling older adults: incidence and risk factors

OBJECTIVES: To investigate the incidence of fear of falling (FOF) and the risk factors associated with transient versus persistent FOF in community‐dwelling older adults. DESIGN: Prospective cohort study. SETTING: Bronx County, New York. PARTICIPANTS: Three hundred eighty participants without FOF at baseline in the Einstein Aging Study aged 70 and older. MEASUREMENTS: FOF was assessed at baseline and during follow‐up interviews at 2‐ to 3‐month intervals for a minimum 2 years. Incident FOF was classified as transient or persistent FOF. Transient FOF was defined as new‐onset FOF reported at only one interview, and persistent FOF was FOF reported at two or more interviews over a 2‐year period. RESULTS: Twenty‐four‐month cumulative incidence of incident FOF was 45.4%, with 60.0% of FOF being persistent. Predictors of incident FOF included female sex (adjusted hazard ratio (aHR)=1.55, 95% confidence interval (CI)=1.08–2.23), depressive symptoms (aHR=1.16, 95% CI=1.07–1.26), falls (aHR=1.50, 95% CI=1.01–2.21), and clinical gait abnormality (aHR=2.07, 95% CI=1.42–3.01). The proportion of participants with incident FOF increased linearly with increasing number of risk factors. Predictors for transient and persistent FOF were depressive symptoms and clinical gait abnormality. Female sex and previous falls were predictors of persistent but not transient FOF. CONCLUSION: FOF status in older adults may change over time, with shared and distinct risk factors for persistent and transient FOF. Understanding the dynamic nature of FOF and these risk factors will help identify high‐risk groups and design future intervention studies.     

Development, implementation, and evaluation of an Interprofessional Falls Prevention Program for older adults

This article describes the development and implementation of an Interprofessional Falls Prevention Program (IFPP) designed for community-dwelling seniors. The program was a collaborative pilot research study conducted in a retirement home and an outpatient hospital setting. The pilot was successful and was positioned into a permanent falls prevention program. The IFPP aimed at improving physical function and balance and reducing the fear of falling in seniors with a history of falls. The pilot study included an interprofessional falls assessment followed by a 12-week program of once-weekly group education and exercise sessions, 3- and 6-month follow-up visits, and individual counseling. To measure program effectiveness, the Berg Balance Scale, the Timed Up and Go Test, the Falls Efficacy Scale, and the Morse Fall Risk Scale were used at baseline, upon program completion, and at 3- and 6-month follow-up. Process measures were also collected, including patient satisfaction. Persistent improvements were found in participants' balance, strength, functional mobility, and fear of falling. Patient satisfaction with the program was high. Challenges faced in program implementation are also highlighted.     

Fear of Falling and Quality of Life of Apparently-Healthy Elderly Individuals from a Nigerian Population

Ageing is associated with increased morbidity, increased fear of falling (FOF) and reduced activity. These may consequently impair the quality of life (QOL) of the elderly. Studies from Africa investigating FOF and its relationship with QOL among elderly individuals are rare. This study investigated the prevalence of FOF and QOL of apparently-healthy elderly residents of two Local Government Areas (LGAs) from Anambra State, Nigeria and also determined the relationship between the two variables. Two hundred and sixty-one (131 males and 130 females) volunteering elderly individuals, from three randomly-selected communities from each of the LGAs, participated in this cross-sectional survey. The Modified Fall Efficacy Scale (MFES) and the Short-Form Health Survey 36-item (SF-36) questionnaire were used to evaluate FOF and QOL respectively. Data were analysed using frequency, percentage, mean and standard deviation, Chi-square, Independent t-test, Pearson correlation and multivariate regression analysis statistics. Alpha level was set at 0.05. FOF was markedly prevalent in the population at 23.4 % and the QOL score of 55.27?±?17.28 was just modest. QOL was particularly low in the role limitations due to the physical and emotional problems domains but high in the mental health, social function and bodily pain domains. Significant relationship was found between FOF and all the QOL domains. FOF was present in nearly one of every four elderly individuals in the sample and was related to their QOL. FOF should be routinely investigated in community-dwelling elderly and strategies devised to combat it.     

Tai Chi and fall reductions in older adults: a randomized controlled trial

BACKGROUND: The authors' objective was to evaluate the efficacy of a 6-month Tai Chi intervention for decreasing the number of falls and the risk for falling in older persons. METHODS: This randomized controlled trial involved a sample of 256 physically inactive, community-dwelling adults aged 70 to 92 (mean age, 77.48 years; standard deviation, 4.95 years) who were recruited through a patient database in Portland, Oregon. Participants were randomized to participate in a three-times-per-week Tai Chi group or to a stretching control group for 6 months. The primary outcome measure was the number of falls; the secondary outcome measures included functional balance (Berg Balance Scale, Dynamic Gait Index, Functional Reach, and single-leg standing), physical performance (50-foot speed walk, Up&Go), and fear of falling, assessed at baseline, 3 months, 6 months (intervention termination), and at a 6-month postintervention follow-up. RESULTS: At the end of the 6-month intervention, significantly fewer falls (n=38 vs 73; p=.007), lower proportions of fallers (28% vs 46%; p=.01), and fewer injurious falls (7% vs 18%; p=.03) were observed in the Tai Chi group compared with the stretching control group. After adjusting for baseline covariates, the risk for multiple falls in the Tai Chi group was 55% lower than that of the stretching control group (risk ratio,.45; 95% confidence interval, 0.30 to 0.70). Compared with the stretching control participants, the Tai Chi participants showed significant improvements (p<.001) in all measures of functional balance, physical performance, and reduced fear of falling. Intervention gains in these measures were maintained at a 6-month postintervention follow-up in the Tai Chi group. CONCLUSIONS: A three-times-per-week, 6-month Tai Chi program is effective in decreasing the number of falls, the risk for falling, and the fear of falling, and it improves functional balance and physical performance in physically inactive persons aged 70 years or older.     

Is there a relationship between short FES-I test scores and objective assessment of balance in the older people with age-induced instability?

Fear of falling (FOF) is a common problem among the elderly. The purpose of this study is to evaluate whether there is a correlation between FOF, estimated via the short FES-I test, and objective evaluation of balance in a group of elderly patients with age-related instability. The balance of 139 subjects of more than 65 years of age is evaluated by the timed up and go test and the computerised dynamic posturography (CDP). Different groups of elderly patients were established according to the number of falls in the previous 12 months, and the correlation with short FES-I test scores was evaluated. Based on the results, ROC curves were calculated. The short FES-I test presents a good capacity to distinguish between subjects with ≤3 falls/year and subjects with ≥4 falls/year (AUC 0.719, 95%CI 0.627–0.810). A test score of 14.5 is the best cut-off point (74% sensitivity, 51% specificity). Using this cut-off point, the study sample comprises two groups: subjects with test scores of 7–14 vs 15–28, with the first group obtaining best results with statistical significance (Student’s t-test and the Mann–Whitney test) in most of the balance tests. The short FES-I is an excellent instrument that measures FOF in the elderly, and it is correlated with their number of falls both in real life and on the CDP. It is simple and fast, and so can be considered an extraordinary screening test relative to real risk of falls in the elderly.