防跌倒护理干预在老年病科应用的效果观察

目的:探讨防跌倒护理干预在老年病科应用对其认知行为的影响。方法:选取2010年1月～2010年11月在我院老年病科住院患者350例,随机分为干预组和对照组各175例,对干预组患者进行防跌倒护理干预,帮助掌握跌倒的相关因素及预防措施,对照组仅予以传统的护理干预,比较2组患者跌倒发生率情况。结果:干预组患者对预防跌倒的认知力明显高于对照组患者(均p<0.05),且住院期间跌倒事件的发生率明显少于对照组(P<0.01),2组比较差异有显著意义。结论:应用防跌倒护理干预能有效降低住院患者跌倒的发生率。     

Translating a Multifactorial Fall Prevention Intervention into Practice: A Controlled Evaluation of a Fall Prevention Clinic

Although multifactorial fall prevention interventions have been shown to reduce falls and injurious falls, their translation into clinical settings has been limited. This article describes a hospital‐based fall prevention clinic established to increase availability of preventive care for falls. Outcomes for 43 adults aged 65 and older seen during the clinic's first 6 months of operation were compared with outcomes for 86 age‐, sex‐, and race‐matched controls; all persons included in analyses received primary care at the hospital's geriatrics clinic. Nonsignificant differences in falls, injurious falls, and fall‐related healthcare use according to study group in multivariate adjusted models were observed, probably because of the small, fixed sample size. The percentage experiencing any injurious falls during the follow‐up period was comparable for fall clinic visitors and controls (14% vs 13%), despite a dramatic difference at baseline (42% of clinic visitors vs 15% of controls). Fall‐related healthcare use was higher for clinic visitors during the baseline period (21%, vs 12% for controls) and decreased slightly (to 19%) during follow‐up; differences in fall‐related healthcare use according to study group from baseline to follow‐up were nonsignificant. These findings, although preliminary because of the small sample size and the baseline difference between the groups in fall rates, suggest that being seen in a fall prevention clinic may reduce injurious falls. Additional studies will be necessary to conclusively determine the effects of multifactorial fall risk assessment and management delivered by midlevel providers working in real‐world clinical practice settings on key outcomes, including injurious falls, downstream fall‐related healthcare use, and costs.     

食管、贲门癌术后胃管、十二指肠营养管脱落原因分析及护理

目的：探讨食管、贲门癌术后胃管、十二指肠营养管脱落原因分析及护理对策。方法：对食管癌贲门癌术后发生胃管、十二指肠营养管脱落的原因分析,脱落13例。结果：针对脱管原因,采取了对应的护理措施,避免脱管再次发生。结论：做好心理护理及术前、术后的健康教育,固定管道,观察患者的病情动态,使脱管现象不再发生。     

Risk of dementia associated with the ApoE epsilon4 allele and falls causing head injury without explicit traumatic brain injury

Objectives –  Severe head injury (HI) and the apolipoprotein E (ApoE) ɛ4 allele are risk factors for dementia. The corresponding effect of falls causing HI without explicit traumatic brain injury (TBI) in association with the ApoE ɛ4 is not known.
Materials and methods –  Altogether 134 persons aged 70 years or older constituted a retrospective population sample, who scored ≥26 in the MiniMental State Examination (MMSE) test at baseline and were clinically examined for dementia 9 years afterward. Fall-related HI causing superficial laceration or bruises or wounds that require suturing were prospectively recorded during the 9-year follow-up. We used Cox regression with age at the diagnosis of dementia as a dependent variable.
Results –  Twenty-eight (21%) subjects had falls causing HI without explicit TBI, the ApoE ɛ4 allele was seen in 44 (33%), and clinical dementia was diagnosed in 25 (19%). Adjusted for the baseline MMSE score, sex and educational status, the hazard ratio for subsequent dementia in subjects having falls with HI without explicit TBI and the ApoE ɛ4 allele as compared with those who do not possess these characteristics was 2.70 (95% confidence interval, 1.02–7.16).
Conclusions –  According to the results of this small retrospective study, falls with HI without explicit TBI in connection with the ApoE ɛ4 allele is associated with subsequent dementia among older adults.     

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.     

The effects of multifactorial fall prevention on depressive symptoms among the aged at increased risk of falling

OBJECTIVES: The aim was to determine the effects of multifactorial fall prevention on depressive symptoms among aged Finns at increased risk of falling. METHODS: This study is part of a multifactorial fall prevention trial with a randomised controlled design implemented in the town of Pori, western Finland. The study population consisted of ambulatory, 65-year-old or older Finns, with moderate or high cognitive and physical abilities who had fallen at least once during the previous 12 months. The participants (n=591) were randomised into a risk-based multifactorial fall prevention programme (intervention group, IG) or into a one-time counselling group (control group, CG). The 1-year intervention included individual geriatric assessment followed by treatment recommendations, individual guidance regarding fall prevention, physical exercise in small groups twice a month, psychosocial group activities and lectures once a month, home-exercises and home hazard assessment. The outcome, depressive symptoms, was measured by the 30-item Geriatric Depression Scale (GDS). RESULTS: The full GDS data with no missing items were available for 464 persons. A significant decrease in depressive symptoms during the 12-month intervention was found both in IG and in CG, but the difference in change was not significant (p=0.110). However, a significant difference in change between the groups was found among men and older subjects (>or=75) in favour of the IG. CONCLUSION: Multifactorial fall prevention had no effects on depressive symptoms among the community-dwelling aged. However, men and older participants benefited from the intervention.     

住院病人跌倒管理中护士自我评价与真实世界跌倒事件的反思与启示

目的:通过传染病专科医院护理人员对于跌倒管理现状的自评及以往跌倒事件的回顾性梳理与分析,挖掘现有跌倒管理体系中的问题,剖析并思考,为今后建立针对不同医疗机构特点的跌倒管理路径的深入研究提供思路。方法:本研究采用横断面研究设计与回顾性分析,于2019年7月1日—2019年8月31日选择在北京地区某传染病专科医院研究期间工作的所有在岗注册护士展开调研,采用《住院病人跌倒预防之临床护士工作自评量表》进行数据收集。同时针对过去5年间该医院发生的41例跌倒事件展开回顾性分析,发现现存问题,探讨管理新思路。结果:参与自评调查的342名护理人员自我评价得分为(242.06±16.21)分,显示出较好的认知水平及预防跌倒的执行力。不同人事编制的护士对陪侍人的宣教工作、不同岗位护士对跌倒标识的管理能力、不同学历护士对病人提供生活用具的意识与能力、不同年龄段护士对后勤部门的协作能力比较差异均存在统计学意义(P<0.05)。结合过去几年间院内发生的41例跌倒事件进行分析,跌倒病人年龄为29~86岁,其中男性27例,女性14例,ADL评分≥60分者30例,事件发生前的最近跌倒风险评分显示无风险者或轻度风险者36例,无视力障碍者39例,无意识障碍者38例,有陪护者27例。病人自理能力、跌倒风险评估均为较好状态下发生的跌倒事件与护士对自我工作评测的高分值之间出现了巨大的差异。结论:护理人员对于跌倒防范管理自我执行力评价的高分值与目前各级医疗机构对于跌倒预防管理工作的重视性相关,但是跌倒事件依然发生的事实以及尤其是在身体状况较好、跌倒风险低的人群中发生的真实情况。临床症状观察与评估的科学化开发、跌倒评估系统个性化的改进、多学科合作及病人的共同参与、护理人员管理中的合理分工、健康宣教策略的改进等都将是今后跌倒管理中需要重点关注的部分。     

老年人药源性跌倒风险研究与干预进展

跌倒是老年人因伤害致死的首要原因, 导致老年人高跌倒风险的因素众多且复杂, 增加跌倒风险的药物(fall-risk increasing drugs, FRIDs)是重要的危险因素之一。FRIDs主要包括作用于中枢神经系统的药物、导致低钠血症和低血糖的药物、易导致晕厥的药物以及多重用药。目前, 跌倒风险评估工具与干预措施多关注于非药物管理, 针对药源性跌倒风险的评估与管理缺乏针对性。基于FRIDs的药师干预和计算机辅助决策系统的预警与管理有助于降低老年人的跌倒风险, 提高老年人的健康水平和生活质量, 减少跌倒所带来的伤害。     

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