养老机构老人跌倒现状分析

[目的]了解养老机构老人跌倒现状,分析跌倒相关因素。[方法]选取南京市3所养老机构内愿意合作的74名老人进行养老机构老人跌倒现状的问卷调查。[结果]养老机构老年人跌倒发生率为39.2%,影响因素包括睡眠状况、慢性病史和服药史。[结论]养老机构老年人跌倒发生率较高,需要采用有效的预防干预措施来减少老年人跌倒的发生。     

住院老年患者跌倒的相关因素及护理进展

<正>随着中国社会经济和医疗保健的进步及发展,人的寿命不断延长,老年患者所占比例不断增加,老年住院患者意外跌倒也日益引起学者的关注。文献报道[1-2],医院内65岁的老年患者跌倒发生率达到30%,80岁以上的老年患者跌倒的年发生率高达50%。跌倒可严重影响老年患者的健康和生活质量,增加患者的痛苦,给家庭和社会带来经济负担。三级综合医院评审标准实施细则(2011年版)患者安全目标之一就是"防范与减少患者跌倒、坠     

住院患者跌倒风险评估量表的修订与信度、效度检验

目的：对Morse跌倒评估量表进行修订,为评估住院患者跌倒风险程度提供适用工具,为落实相应干预措施提供依据。方法：查阅文献、咨询专家,确定住院患者跌倒危险因素,修订量表,再通过预试验调查,专家考评,反复改进与修订,形成包含5个维度12个条目的评估量表。对456例住院患者进行测评,分析量表应用的信度、效度,并与效标量表进行效标效度及灵敏度和特异度分析。结果：总量表内部一致性Cronbach’sα系数为0.891,各维度Cronbach’sα系数为0.530～0.796;重测信度0.982,各维度重测信度为0.650～0.994。各条目得分与总分Peason相关系数在0.500～0.813之间,呈正相关,差异有统计学意义（P=0.000）;共提取2个公因子,累计方差贡献率为59.293%,各因子载荷范围为0.490～0.900。修订量表总分与效标量表呈正相关,相关系数0.709,灵敏度为89.4%,特异度为97.3%。结论：修订后的住院患者跌倒风险评估量表具有较好的信度和效度,可用于所有住院患者的跌倒风险评估,并能筛选出不同风险程度,为临床护理进行针对性的跌倒预防、监控提供依据。     

根因分析法在老年患者跌倒管理中的应用

目的：探讨根因分析法（RCA）在老年患者跌倒中的应用及效果。方法：应用RCA对住院老年患者跌倒个案进行调查分析,确定根本原因,制定并落实改进措施,比较应用RCA前后的实施效果。结果：应用RCA前后老年患者跌倒发生率有统计学差异（P〈0.05）,跌倒率由3.12‰下降到了0.92‰。结论：RCA对预防老年患者跌倒管理具有很好的导向作用。保证环境设施安全是预防跌倒的前提;强化系统安全建立是预防跌倒的根本;指导训练老年患者良好的健康行为是预防跌倒的关键;合理配置夜班护理人力资源是预防跌倒的主要手段。     

阶段性改变模式行为干预预防复发脑卒中患者跌倒的效果观察

目的探讨阶段性改变模式行为干预预防复发脑卒中患者跌倒的效果。方法将172例复发脑卒中患者,根据随机数字表分为干预组87例和对照组85例。干预组住院期间及出院后给予阶段性改变模式的行为干预措施,包括无意图期、意图期、准备期、行动期和维持期干预,评估患者所属阶段实施相应干预措施;对照组接受常规健康教育及出院后指导。两组患者分别于出院后1周、3个月、6个月进行电话随访,比较两组间跌倒发生率。结果出院6个月干预组失访5例,发生跌倒5例;对照组失访9例,发生跌倒16例,两组失访患者一般资料差异无统计学意义,跌倒发生率比较,差异有统计学意义(χ2=6.412,P=0.011)。结论运用阶段性改变模式进行行为干预,可以降低复发脑卒中患者跌倒的发生率,帮助脑卒中患者建立健康的行为模式。     

认知功能对恢复期缺血性脑卒中老年患者跌倒风险的影响

目的探讨认知功能对恢复期缺血性脑卒中老年患者跌倒风险的影响。方法采用整群抽样法,运用蒙特利尔认知评估量表评估患者认知功能,Faster counting while walking测试法评估患者跌倒风险。将认知功能和跌倒风险纳入单因素及多因素Logistic回归模型筛选预测因子。结果跌倒高危风险组和低危风险组的认知总分、注意力、抽象能力和定向力得分差异有统计学意义。既往职业类型,认知总分,认知维度中的注意力、抽象能力和定向力对恢复期缺血性脑卒中老年患者跌倒风险具有预测作用。结论认知功能对恢复期缺血性脑卒中老年患者跌倒风险具有预测作用,关注认知因素对恢复期缺血性脑卒中老年人群跌倒的重要影响,可及时、动态地发现跌倒高危对象,以降低跌倒发生率。     

Characteristics of syncopal falls in community-living older people transported to an emergency department

In older people, falls are major reasons for transporting to emergency departments (ED). Falls are etiologically classified into syncopal falls and non-syncopal ones. The aim of this study is to clarify the characteristics of syncopal falls in community-living older people transported to ED. The retrospective chart review was performed on patients older than 65 years, transported to the ED of Keio University Hospital in Tokyo because of falls during a 12-month period. Age, sex, blood pressure and pulse rate at the arrival to ED, episode of syncope, type of fall, sustained injury and medical problems were screened. We analyzed the differences between syncopal falls and non-syncopal ones. Patients with syncopal falls were given blood tests, electrocardiograms, and standing tests for orthostatic hypotension. The number of syncopal falls was 33 (29.5%), and that of non-syncopal ones was 79 (69.3%). Syncopal falls frequently occurred on same level compared with from one level to another (84.8% versus 9.1%). In patients with syncopal falls, the frequency of falling on the same level was significantly higher than that in patients with non-syncopal falls (84.8% vs 60.8%). Patients with syncopal falls significantly sustained fewer fractures (12.1% vs 34.2%), and used more antihypertensive agents (45.5% vs 18.9%) than those with non-syncopal ones, respectively. The 14 syncopal fall patients were given standing tests, and four patients presented orthostatic hypotension. In community-living older people transported to ED, syncopal falls frequently occurred on the same level, and the patients with syncopal falls were found to have sustained fewer fractures and use more antihypertensive agents.     

Tests of stepping as indicators of mobility, balance, and fall risk in balance-impaired older adults

OBJECTIVES: To determine the relationships between two tests of stepping ability (the maximal step length (MSL) and rapid step test (RST)) and standard tests of standing balance, gait, mobility, and functional impairment in a group of at-risk older adults. DESIGN: Cross-sectional study. SETTING: University-based laboratory. PARTICIPANTS: One hundred sixty-seven mildly balance-impaired older adults recruited for a balance-training and fall-reduction program (mean age 78, range 65-90). MEASUREMENTS: Measures of stepping maximally (MSL, the ability to maximally step out and return to the initial position) and rapidly (RST, the time taken to step out and return in multiple directions as fast as possible); standard measures of balance, gait, and mobility including timed tandem stance (TS), tandem walk (TW, both timing and errors), timed unipedal stance (US), timed up and go (TUG), performance oriented mobility assessment (POMA), and 6-minute walk (SMW); measures of leg strength (peak knee and ankle torque and power at slow and fast speeds); self-report measures of frequent falls (>2 per 12 months), disability (Established Population for Epidemiologic Studies of the Elderly (EPESE) physical function), and confidence to avoid falls (Activity-specific Balance Confidence (ABC) Scale). Spearman and Pearson correlation, intraclass correlation coefficient, logistic regression, and linear regression were used for data analysis. RESULTS: MSL consistently predicted a number of self-report and performance measures at least as well as other standard balance measures. MSL correlations with EPESE physical function, ABC, TUG, and POMA scores; SMW; and peak maximum knee and ankle torque and power were at least as high as those correlations seen with TS, TW, or US. MSL score was associated with the risk of being a frequent faller. In addition, the six MSL directions were highly correlated (up to 0.96), and any one of the leg directions yielded similar relationships with functional measures and a history of falls. Relationships between RST and these measures were relatively modest. CONCLUSION: MSL is as good a predictor of mobility performance, frequent falls, self-reported function, and balance confidence as standard stance tests such as US. MSL simplified to one direction may be a useful clinical indicator of mobility, balance, and fall risk in older adults.     

中重度老年痴呆住院病人跌倒与噎食风险及病人特征的研究

[目的]对中重度老年痴呆病人的跌倒和噎食风险进行评定并探讨高风险病人的特征,为临床护士实施相应的安全防范措施提供依据.[方法]采用方便抽样方法选取北京市某精神病院中重度老年痴呆住院病人51例,使用噎食和跌倒风险评估表、Barthel指数评定量表进行评估.[结果]51例病人中,具有跌倒和噎食风险的病人分别占52.9％和90.2％;既往来发生过跌倒或噎食的病人亦具有跌倒或噎食的高风险;跌倒风险与噎食风险不具有一致性（x2＝1.17,P=0.28）;年龄越大,痴呆病人发生跌倒（t=-2.30,P=0.03）和噎食（t=2.37,P=0.02）的风险就越高;自理能力低的病人跌倒风险高（t=-2.30,P＝0.03）.[结论]中重度痴呆病人具有较高的跌倒风险与噎食风险;两种风险评估需要独自评定,不能相互取代;既往没有跌倒史或噎食史的中重度痴呆病人也需要重点预防跌倒或噎食的发生;高龄病人和自理能力差者为需要重点关注的人群.