老年人跌倒的公共卫生研究进展

  目的  了解中国社区老年人跌倒及跌倒后受伤情况,为采取相应的干预措施提供参考依据。  方法  收集老年期重点疾病预防和干预项目（PINDEC）2018年7 — 10月北京、上海、湖北、四川、云南、广西6个地区共21084名 ≥ 60岁社区老年人的追踪随访数据,分析过去1年老年人的跌倒情况以及跌倒后受伤情况。  结果  中国21084名社区老年人中,过去1年发生跌倒者2979人,经复杂加权后跌倒发生率为14.7 %,不同性别、年龄、文化程度、婚姻状态、职业、工作状况和居住地社区老年人跌倒发生率差异均有统计学意义（均P < 0.001）;过去1年发生跌倒的2979名社区老年人中,因跌倒受伤者2252例,经复杂加权后跌倒后受伤比例为79.5 %,不同性别、年龄、文化程度、职业、工作状况和居住地社区老年人跌倒后受伤比例差异均有统计学意义（均P < 0.01）;因跌倒而受伤的2252名社区老年人中,受伤类型为擦伤/挫伤、手/胳膊骨折、股骨头骨折、髋部骨折、头部受伤和其他类型伤者分别为1472、242、101、89、167和416例,经复杂加权后比例分别为70.1 %、10.0 %、4.6 %、2.4 %、7.0 %和15.3 %。  结论  中国社区老年人中跌倒发生率较高,且跌倒后受伤比例亦较高,擦伤/挫伤是最主要的受伤类型。     

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.     

老年人跌倒的危险因素与风险评估研究进展

跌倒是老年人常见的意外事件,随着老龄化的加剧,老年人跌倒已成为一个日益严重的公共卫生问题。发达国家[1]研究发现,居住在社区的65岁及以上的老人大约有1/3在1年中发生过跌     

The burden of hospitalised fall‐related injury in community‐dwelling older people in Victoria: a database study

Objective : To estimate the burden of hospitalised fall‐related injury in community‐dwelling older people in Victoria. Methods : We analysed fall‐related, person‐identifying hospital discharge data and patient‐level hospital treatment costs for community‐dwelling older people aged 65+ years from Victoria between 1 July 2005 and 30 June 2008, inclusive. Key outcomes of interest were length of stay (LOS)/episode, cumulative LOS (CLOS)/patient and inpatient costs. Results : The burden of hospitalised fall‐related injury in community‐dwelling older people aged 65+ years in Victoria was 284,781 hospital bed days in 2005–06, rising to 310,031 hospital bed days in 2007–08. Seventy‐one per cent of episodes were multiday. One in 15 acute care episodes was a high LOS outlier and 14% of patients had ≥1 episode classified as high LOS outlier. The median CLOS/patient was nine days (interquartile range 2–27). The annual costs of inpatient care, in June 2009 prices, for fall‐related injury in community‐dwelling people aged 65+ years in Victoria rose from $213 million in 2005–06 to $237 million in 2007–08. The burden of hospitalised fall‐related injury in community‐dwelling older women, people aged 85+ years and those with comorbidity was considerable. Conclusions : The burden of hospitalised fall‐related injury in community‐dwelling older people aged 65+ years in Victoria is significantly more than previously projected. Importantly, this study identifies that women, patients with comorbidity and those aged 85+ years account for a considerable proportion of this burden. Implications : A corresponding increase in falls prevention effort is required to ensure that the burden is properly addressed.     

Exploring purpose‐designed audio‐visual falls prevention messages on older people's capability and motivation to prevent falls

The number of falls and fall‐associated injury rates among older people continues to rise worldwide. Increased efforts to influence older people's falls prevention behaviour are needed. A two‐phase exploratory community‐based participatory study was conducted in Western Australia. First, three prototype audio‐visual (AV) falls prevention messages were designed collaboratively with six older people. Second, the messages’ effect on community‐dwelling older people's knowledge, awareness and motivation to take action regarding falls prevention was explored using focus groups. Data were analysed using thematic analysis to explore participants’ responses to the messages. The participants’ (n = 54) perspectives on the AV messages varied widely and stereotypes of ageing appeared to influence these. The presented falls facts (including falls epidemiology statistics) increased some participants’ falls risk awareness and falls prevention knowledge. Other participants felt ready‐to‐use falls prevention information was lacking. Some expressed positive emotions or a personal connection to the messages and suggested the messages helped reduce ageing‐related stigma. Strongly opposing viewpoints suggested that other participants identified implicit negative messages about ageing, which reduced their motivation with the messages. Suggestions to improve the message persuasiveness included adding more drama and tailoring messages to appeal to multiple age groups. Overall, the AV falls prevention messages designed in collaboration with older people elicited a divergent range of positive and negative perspectives from their peers, which was conceptualised by the overarching theme ‘we all look at things different ways’. Opinions differed regarding whether the messages would appeal to older people. Public campaigns targeting falls prevention should be designed and tailored towards older peoples’ differing perspectives about ageing.     

Internet provision of tailored advice on falls prevention activities for older people: a randomized controlled evaluation

Falls are very common in older persons and can result in substantial disability and distress. By undertaking strength and balance training (SBT) exercises, older people can reduce their risk of falling. The Internet offers a potentially cost-effective means of disseminating information about SBT to older people and their carers. A particular advantage of using the Internet for this purpose is that the advice given can be 'tailored' to the needs of the individual. This study used a randomized controlled design to evaluate an interactive web-based program that tailored advice about undertaking SBT activities. The participants were 280 people with an age range of 65-97 years recruited by advertising the website by email and the Internet. Those randomized to the tailored advice were presented with advice tailored to their personal self-rated balance capabilities, health problems and activity preferences. Those in the control group were presented with all the advice from which the tailored advice was selected. After reading the advice, those in the tailored advice group (n = 144) had more positive attitudes (p < 0.01) than those in the control group (n = 136), reporting greater perceived relevance of the SBT activities, greater confidence in the ability to carry them out, and hence stronger intentions to undertake the activities. This study provides an initial indication that an interactive website might offer a cost-effective way to provide personalized advice to some older people. Further research is required to determine whether website-based advice on falls prevention changes behavior as well as intentions and whether the advice needs to be supplemented by other forms of support.     

Risk factors for falls among Iowa farmers: a case-control study nested in the Agricultural Health Study

BACKGROUND: Farmers are at increased risk for fall-related injury compared with other occupations. Little is known about risk factors for non-fatal falls on the farm. This case-control study, nested within the Agricultural Health Study, aimed to assess risk factors for work-related falls among Iowa farmers. METHODS: A screener questionnaire sent to 6,999 farmers in 1998 identified 79 farmers who reported a fall-related farm injury that required medical advice or treatment in the previous year. Multivariable logistic regression analysis was used to assess several possible risk factors for injury among these farmers compared with 473 farmers with no injury in the previous year. RESULTS: There were significant associations between fall-related farm injury and age between 40 and 64 years (OR = 2.21; 95% CI = 1.20-4.07), doctor-diagnosed arthritis/rheumatism (OR = 2.05; 95% CI = 1.11-3.79), difficulty hearing normal conversation (even with a hearing aid, in the case of those who used one) (OR = 1.82; 95% CI = 1.07-3.08), and taking medications regularly (OR = 1.80; 95% CI = 1.02-3.18). CONCLUSIONS: Aging and health impairments, such as arthritis and hearing difficulties, are risk factors for which accommodations and preventive strategies can be devised to prevent fall-related injuries on the farm.     

Low‐income homebound older adults receiving home‐delivered meals: Physical and mental health conditions,incidence of falls and hospitalisations

Significant differences in health across racial/ethnic and socioeconomic groups in the US signal increasing numbers of low‐income homebound older adults in a rapidly ageing society. The purpose of this study was to examine physical and psychiatric conditions and their association with incidence of self‐reported falls and hospitalisations among largely low‐income and racial/ethnic minority adults age 50+ (N = 2,224), clients from a home‐delivered meals programme in Central Texas. Data came from comprehensive, in‐home assessments done in 2017 by these older adults’ case managers. We used bivariate analyses to compare those with and without incidence of self‐reported past‐year falls and those with and without a hospitalisation episode with respect to their sociodemographic and clinical characteristics. We used multivariable logistic regression analysis to examine sociodemographic and clinical correlates of any incidence of falls and negative binomial regression analysis to examine these correlates of the number of hospitalisations in the preceding 12 months. The rates of chronic physical illnesses, including cardiovascular disease, diabetes, gastrointestinal disease, lung disease and renal failure, were extremely high. The 41% of reported falls among the study sample was also higher than the rate among US older adults in general. More diagnosed physical illnesses, depression, chewing/swallowing problems, chronic/severe pain, activities and instrumental activities of daily living (ADL/IADL) impairments and ambulation assistive device use were associated with greater odds of falling. The rate of past‐year hospitalisation was 26%, and more diagnosed physical illnesses, ADL/IADL impairments, ambulation assistive device use and any fall incidence were positively associated with the number of hospitalisations. These findings indicate the need for fall prevention programmes for frail homebound older adults as well as health and social care services that help older adults better manage physical/mental health problems and reduce preventable health crises and hospitalisations.     

Twelve‐month post‐injury outcomes for Māori and non‐Māori: findings from a New Zealand cohort study

Objective : To examine the prevalence of key outcomes among Māori and non‐Māori 12 months post‐injury, and to estimate the risk of these outcomes for Māori compared to non‐Māori. Methods : The Prospective Outcomes of Injury Study recruited 2,856 New Zealand residents from five regions of New Zealand. This paper examines outcomes at 12 months post‐injury for the Māori (n=405) and non‐Māori (n=1,875) groups. Results : High levels of adverse outcomes at 12 months post‐injury were observed in both groups. A greater proportion of Māori than non‐Māori were experiencing disability, problems with mobility and psychological distress 12 months post‐injury. After controlling for pre‐injury and injury‐related characteristics, Māori were found to be at greater risk of disability, problems with mobility, having trouble performing usual activities, psychological distress and reporting ‘barely/not enough’ household income at 12 months compared to non‐Māori. Conclusion : Explanations for higher risk of these poor outcomes are unclear. Future research to identify potential explanations will include experiences with health services and rehabilitation support following injury, subsequent injury and illness, and major life events post‐injury. Implications : Adequate post‐injury care focused on physical and psychological health and financial security is required to reduce the burden experienced by Māori due to injury.     

The impact of geographical location on trends in hospitalisation rates and outcomes for fall‐related injuries in older people

Objective : This population‐based study investigates the influence of geographical location on hospital admissions, utilisation and outcomes for fall‐related injury in older adults, adjusting for age, sex and comorbidities. Methods : A linked dataset of all admissions of NSW residents aged 65 and older, hospitalised at least once for a fall‐related injury between 2003 and 2012, was used to estimate rates of hospitalisations, total lengths‐of‐stay, 28‐day readmissions, and 30‐day mortalities. These were standardised for age, sex, comorbidity, and remoteness. Results : Compared to urban residents, rural residents were hospitalised less (p<0.0001) and hospitalisation rates increased at a lower rate (0.8% vs 2.6% per year) from 2003 to 2012. Rural residents had a shorter median total length of stay (5 vs 7 days, p<0.0001), a higher 28‐day readmission rate (18.9% vs 17.0%, p<0.0001) and higher 30‐day mortality (5.0% vs 4.9%, p=0.0046). Conclusions : Over the study period, rural residents of NSW had lower rates of fall‐related injury hospitalisation and a lower annual increase in hospitalisation rates compared to urban residents. When hospitalised, rural residents had a shorter length‐of‐stay, but higher rates of readmission and mortality. These differences existed following standardisation. Implications : This study highlights the need for further research to characterise and explain this variability.     

Risk and protective factors for breast cancer: a systematic review

This review aimed to investigate risk and protective factors for breast cancer and to analyze whether scientific evidence from the World Cancer Research Fund and American Institute for Cancer Research, published in 2007, was confirmed by new research. In May 2010 we reviewed cohort and case-control analytical studies from 2007 to 2010 in the PubMed, LILACS, and SciELO databases. We selected 27 articles (14 case-control and 13 cohort studies). Breastfeeding and physical activity were protective factors against breast cancer, and alcohol consumption was a risk factor. A direct proportional relationship was observed between larger waist circumference, weight throughout adulthood, and height and risk of breast cancer in postmenopausal women. The association between body fat and breast cancer is contradictory in both premenopausal and postmenopausal women. According to the accumulated evidence, breastfeeding and healthy lifestyle are the factors most strongly associated with breast cancer prevention.     

Anemia increases risk for falls in hospitalized older adults: an evaluation of falls in 362 hospitalized, ambulatory, long-term care, and community patients

OBJECTIVE: The objective of this study was to determine if a relationship exists between the presence of anemia and the occurrence of falls during hospitalization in ambulatory older adults from long-term care and community settings. All individuals were hospitalized for acute conditions not related to a fall. PARTICIPANTS: Three hundred sixty-two hospitalized, ambulatory older (59-104 years) adults. MEASUREMENTS: Laboratory values (hemoglobin [Hb], hematocrit [Hct]), routine laboratory tests, pertinent medical history, and demographics. RESULTS: Ambulatory hospitalized patients who fell were compared to controls (no falls during hospitalization) of similar age (P = .283) and gender distribution (P = .554). Patients who fell had significantly lower Hb (P < .00005), lower Hct (P < .00005) and were more likely to be anemic (56% vs 38%, P = .001) than controls. A logistic regression model examined the effect of Hb level and anemia on falls and included the covariates of age, gender, place of residence, and race. The model described a 22% decreased risk of falls for every 1.0 g/dL increase in Hb (P < .0005) and an overall 1.9-fold increased risk of falls in anemic patients (P < .001). Patient age, gender, and place of residence were not related to the risk of falls during hospitalization. CONCLUSIONS: These findings suggest a potentially important link between anemia and the risk of falls during hospitalization in ambulatory older patients. Further studies are needed to determine if the risk of falls can be modified by correction of anemia and to determine the applicability of these findings to older adults in different settings.     

Incidence, risk factors and consequences of falls among elderly subjects living in the community: A criteria-based analysis

In order to obtain an overview of the incidences, risk factorsand health consequences of falls among elderly persons livingin the community from the available literature, a Medline computersearch of publications over the period 1981–1994 was carriedout. Fourteen studies met the following inclusion criteria:i) the study is an original investigation of falls among theelderly, ii) the study deals with the incidence, risk factorsand/or consequences of falls among the elderly and iii) thestudy refers to a population at risk consisting of persons aged60 years or over belonging to a population relevant to generalpractice. The selected studies were subjected to a methodologicalassessment on the basis of 10 methodological criteria. All thestudies were independently assessed by 1 author and 1 assistantto obtain a methodological consensus. The relevant outcomesof these studies are reported. Pooling of data was not performedbecause of relevant differences between the studies. Two studiesmet all methodological criteria and 2 other studies were secondbest. These 4 studies were given preference. Approximately 30%of subjects older than 65 years fall at least once a year andapproximately 15% fall recurrently. The main risk factors forfalls among the elderly belong to the intrinsic (patient-related)risk factors: cognitive impairment, balance and gait disorders,use of sedatives and hypnotics, a history of stroke, advancedage, arthritis of the knee and a high level of dependence. Extrinsic(environment-related) risk factors did not play a significantrole in any of the studies. Not all studies dealt with the healthconsequences of falls among the elderly. Major injuries werereported in 0.5–9% and fractures in 3–14%.     

秦皇岛市城市社区老年人跌倒的危险因素

  目的  了解河北省唐山市社区高龄老年人跌倒风险与睡眠和运动的关系,为采取应对的干预措施提供参考依据。  方法  于2016年7月 — 2017年1月采用分层随机整群抽样方法在唐山市抽取3 448名 ≥ 75岁社区高龄老年人进行问卷调查。  结果  唐山市社区高龄老年人跌倒风险得分为（8.19 ± 6.74）分;多元线性回归分析结果显示,年龄较高、分居或离异、不经常运动、睡眠质量较差、夜间异醒或早醒次数多、催眠药物使用次数较多和睡眠导致疼痛次数较多的唐山市社区高龄老年人跌倒风险较高。  结论  有睡眠问题或不经常运动均会增加唐山市社区高龄老年人的跌倒风险。