品管圈活动在降低老年住院患者跌倒风险的管理

目的 探索品管圈活动对降低老年住院患者跌倒风险的影响.方法 成立品管圈小组,开展如何减少老年住院患者跌倒风险的活动主题,分析老年住院患者跌倒的风险并采取加强教育培训、加强制度的落实,圈长,圈员定期检查控制、多部门沟通协调的措施,实施质量持续改进.结果 实施品管圈活动后老年住院患着的跌倒发生率从0.14％明显下降到0.05％（x 2=13.26和12.02,P＜0.005）.结论 开展品管圈活动,能提高患者安全性,减少老年住院患者跌倒发生率,增强了护理人员的安全管理意识.     

Assessment and management of falls in older people

Falls remain a major cause of mortality and morbidity for older Australians, despite considerable growth in falls prevention activity in recent years. Risk factors for falls are well defined, and there is a growing evidence base from randomized controlled trials in community settings indicating a range of effective individual and multiple strategy interventions to reduce falls and falls injuries. These range from health promotion approaches, such as group exercise programmes, through to multidisciplinary, multifactorial interventions for high-risk populations. Practitioners need to utilize a range of strategies to enhance uptake and sustained participation in falls prevention activities. Future research needs to address important gaps, such as compliance issues, and interventions for people with cognitive impairment, dizziness and vision loss. Further research is also required in residential care and hospital settings, where there is relatively little research evidence to guide practice.     

Falls and fear of falling: which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention

OBJECTIVES: Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors. DESIGN: A 20-month, population-based, prospective, observational study. SETTING: Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation. PARTICIPANTS: The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher. MEASUREMENTS: Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors. RESULTS: Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P <.0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P <.0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling. CONCLUSION: Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.     

澳门居家老年人跌倒的危险因素分析

目的 分析澳门居家老年人跌倒的危险因素. 方法 以问卷调查的方式成功访谈了2039名60岁及以上的老年人;利用多因素Binary Logistic Regression识别出老年人跌倒的危险因素.结果 在受访的2039名老年人中,3个月内曾发生跌倒者73人(3.6%);多因素回归分析结果 显示高龄,患有痛风、两耳均听不到、家居地面凹凸不平的老年人跌倒的发生率比较高. 结论 老年人服务机构应教育群众特别关心照顾高龄及失聪的老年人,另外去除家居环境的危险因素有利于预防老年人跌倒的发生.     

Determinants of uptake of home modifications and exercise to prevent falls in community‐dwelling older people

Objective: To examine the age‐specific population prevalence and predictors of uptake of home modifications and exercise to prevent falls in the NSW older population. Methods: A total of 5,681 respondents were asked questions on fall prevention activities as part of the 2009 NSW Falls Prevention Survey. Results were weighted to represent the NSW population. Regression analysis was used to determine factors associated with uptake of interventions. Results: Overall, 28.9% of the older population have modified their home, and 35.1% increased exercise to prevent falls. Main predictors of home modification were being aged 85+ (RR 2.04, 95% CI 1.76–2.35) and physiotherapy/occupational therapy intervention (RR 1.57, 95% CI 1.22–2.01). Main predictors of increasing exercise were physiotherapy/OT intervention (RR 2.12, 95% CI 1.86–2.42) and medical advice (RR 1.45, 95% CI1.32–1.60). Older respondents (RR 0.68, 95% CI 0.57–0.81) and those with fair/poor health (RR 0.86, 95% CI 0.77–0.96) were less likely to report increased exercise. Conclusion: More than one‐quarter of the older population of NSW report having made modifications to their home and one‐third increased exercise to prevent falls. There was a clear gradient of increased uptake of home modifications with increasing age, with the reverse trend for increased exercise. Implication: Although fall prevention initiatives are having an impact at the population level, targeted strategies for high‐risk groups are still required.     

1988-2011年哈尔滨市区居民意外伤害死亡及减寿年数分析

目的 研究哈尔滨市区1988-2011年居民意外伤害死亡流行特征及对哈尔滨市区居民潜在寿命损失的影响,为哈尔滨市制定意外伤害防治策略、措施及相应卫生政策提供科学理论依据。方法 采用标化死亡率、潜在寿命损失年（YPLL）和潜在工作损失年（WYPLL）等指标对哈尔滨市区1988-2011年居民意外伤害死亡监测资料进行分析。结果 1988-2011年哈尔滨市区意外伤害总死亡数为26 149例,死亡率33.75/10万,标化死亡率为29.23/10万。0-14岁、15-64岁和≥65岁居民总体伤害水平分别为10.89/10万、34.80/10万和67.43/10万。1988-1999年和2000-2011年居民意外伤害的死亡率分别为39.56/10万和29.07/10万,标化死亡率分别为35.71/10万和24.04/10万。1988-2011年哈尔滨市区居民意外伤害YPLL为774 017.0人/年,YPLL率为9.99‰,标化YPLL率为9.65‰;WYPLL为483 159.0人/年,WYPLL率为6.23‰,标化WYPLL率为6.57‰。结论 机动车辆交通事故、被杀、自杀等意外伤害已成为目前哈尔滨市区居民减寿的主要因子和劳动力损失的主要原因,应针对哈尔滨市区伤害死亡谱和目标人群制定有效的控制策略和干预措施,以降低居民意外死亡率。     

Community-based falls prevention: lessons from an Interprofessional Mobility Clinic

Falls are a common and serious risk with an aging population. Chiropractors commonly see firsthand the effects of falls and resulting injuries in their senior patients and they can reduce falls risk through active screening. Ongoing research has provided proven approaches for making falls less likely. Screening for falls should be done yearly for all patients 65 years and older or in those with a predisposing medical condition. Additional specific falls prevention professional education would enable the chiropractor to best assist these patients. Collaboration and communication with the patient’s family physician offers an opportunity for improved interprofessional dialogue to enhance patient care related to falls risk. Frequently falls prevention strategies are implemented by an interprofessional team. Chiropractors increasingly contribute within multidisciplinary teams. Collaboration by the chiropractor requires both simple screening and knowledge of health care system navigation. Such awareness can permit optimal participation in the care of their patient and the best outcome.