480名社区老年人恐惧跌倒与焦虑抑郁的相关性分析

目的分析老年人恐惧跌倒与焦虑和抑郁的相关性,并评估焦虑和抑郁是否与恐惧跌倒回避程度相关。方法对480例70岁以上恐惧跌倒轻度回避活动的社区老年人的一般资料及焦虑和抑郁情况进行问卷调查,用统计学方法分析其相关性。结果焦虑和抑郁的平均分在恐惧跌倒轻、重度回避中显著不同(t=3.492～4.593,P=0.001),恐惧跌倒重度回避者更易发生焦虑,恐惧跌倒轻度回避者更易发生抑郁。结论焦虑和抑郁在恐惧跌倒的社区老年人中常见,专业护理人员对这些老年群体须高度重视,提供适宜的最优化的心理及药物治疗护理。     

跌倒恐惧症

正跌倒恐惧症(fallaphobia),Tideiksaar和Kay于1986年提出跌倒恐惧症的概念。跌倒恐惧症是指一个人因恐惧跌倒而导致他不敢进行任何可能会跌倒的活动,若尝试去做这些活动,则可能会出现惊慌失措、焦虑、眩晕、心悸等症状。老年人一旦曾经历过跌倒,除了造成机体伤害外,亦会让老年人出现心理恐惧,从而自行减少各种活动机会,减少外出与人交往,导致自我行动能力降低。其结果不但会加速老年人生理功能的退化,更造成其社交范围减缩,对老年人的生理、心理和社会功能均造成严重影响。     

老年人跌倒恐惧评估工具的范围综述

目的对国内外老年人跌倒恐惧评估工具进行总结, 为医护人员评估老年人跌倒恐惧提供参考。方法系统检索中国知网、万方数据库、中国生物医学文献数据库、维普网、Embase、PubMed、Web of Science、Cochrane Library数据库中有关老年人跌倒恐惧评估工具的文献, 检索时限均为建库至2023年7月4日。对跌倒恐惧评估工具的相关内容进行提取、分析。结果共纳入45篇文献, 涉及16种跌倒恐惧评估工具。结论纳入分析的16种跌倒恐惧评估工具以自评形式为主;跌倒恐惧评估工具的信度良好, 但效度仍需进一步验证。建议选择跌倒恐惧评估工具时要综合考虑多方面因素, 并与专业仪器测量的量化客观指标相结合, 以准确评估老年人跌倒恐惧情况。     

老年人害怕跌倒的研究进展

害怕跌倒(Fear of falling,FOF),也称恐惧跌倒,是指在进行某些活动时为了避免跌倒而出现的自我效能或信心降低[1]。FOF普遍存在于老年人中。国外研究[2-3]显示:社区老年人害怕跌倒的发生率为25%~55%,而国内更是达到了58.2%~82.2%[4-5]。FOF不仅可以造成老年人日后跌倒,还会引起老年人活动减少、日常活动受限,最终致老年人生活质量下降。国外研究已证实,运动锻炼可以改善老年人的FOF。本文针对FOF的概念、流行病学、引起的不良后果以及运动锻炼对FOF的影响进行综述,旨在为国内开展相关的研究、为FOF的老年人制订有效的护理措施提供依据。     

老年住院患者跌倒的护理进展

随着人口老龄化进程加快和期望寿命延长,老年人的健康和生活质量日益受到关注。老年人跌倒是一个重要的公共卫生问题[1]。跌倒对老年人的危害性很大,跌倒轻则皮肤组织擦伤、淤血、水肿或撕裂伤,重则骨折、颅内出血甚至死亡 [2]。跌倒还导致老年人日常生活活动能力(ADL)和行走能力的下降,并可导致严重的功能残疾和生活质量的下降。跌倒或险些跌倒还可能使老年人产生担心跌倒的心理而对自己限制活动,使老年人生活依赖性增加和活动能力下降,这样又增加了跌倒的危险性,形成恶性循环。为保持老年人较高生活质量,降低医疗费用支出,减轻社会疾病负担,老年人跌倒的预防控制已成为公共卫生问题和健康问题[3] 。研究老年人跌倒的危险因素、跌倒高危人群评估及预防跌倒的干预措施成为卫生保健专业工作者努力的方向之一,本文对有关老年人跌倒的预防护理现状综述如下。     

社区老年人跌倒的原因与预防

随着人口的老龄化,预防卧床不起已成为重要的研究课题。不少老年人因跌倒骨折而卧床;即使未骨折,跌倒使患者丧失信心、恐惧引起活动能力下降、活动范围受限、生活质量下降(跌倒后综合征),进而更易跌倒而造成恶性循环。跌倒无论对个人生活质量还是医疗费用都有明显影响,因此,分析跌倒的原因以便预防跌倒具有重大意义。     

住院老年人跌倒的预防教育

目的了解医院内老年人跌倒的状况,以更有效地进行预防跌倒的教育.方法以查阅病历、访谈和实地观察跌倒环境获取资料,回顾分析1995～2004年在住院期间发生跌倒的老年人共40例.描述跌倒者的年龄、原有疾病、跌倒发生时间的分布,以及当时是否有人在场、跌倒地点、跌倒与活动的关系等.结果跌倒者以高龄老人居多,老年痴呆、老年精神病、脑梗塞者较多;均发生在室内,在患者独处时发生;跌倒与活动密切相关.无论是否有肢体活动不便,能否自行活动,老年人均存在跌倒的危险.跌倒不仅发生在活动频繁的日间,夜间跌倒例数几乎与日间相同.跌倒后绝大部分发生不同程度损伤.结论老年人群是发生跌倒的高危人群,尤其是高龄老年人;预防教育需在对老年人反复强化教育的基础上,对他们的照护者加强教育;为减少老年人跌倒的发生,应在保持老年人自主能动性的前提下,适量限制老年人、特别是高龄老人的活动范围.老年人的居住休养环境应更适合老年人活动的需要,安装安全设施.对缺乏依从性的老年人应要求其签署跌倒发生危险的知情同意书,以避免不必要的医疗护理纠纷.     

脑卒中患者跌倒恐惧的影响因素及护理对策

目的:研究脑卒中患者跌倒恐惧的影响因素,并对各因素的影响程度进行多维度分析比较,针对性提出相应护理干预措施。方法:选取100例神经内科病房收治的脑卒中患者,包括住院和已出院回院复诊的患者,采用自制一般资料问卷收集患者基本信息;采用Berg平衡量表(BBS)和起立-行走计时试验(TUGT)测定患者平衡功能、移动能力及下肢运动功能;采用活动平衡信心量表(ABC)评估患者对活动平衡的信心。应用单因素分析法评估患者性别、年龄、跌倒史、视力情况、平衡功能、移动能力及下肢运动功能等因素与患者跌倒恐惧的相关性。采用多因素分析法比较其影响程度。结果:年龄、跌倒史、视力情况、平衡功能、移动能力及下肢运动功能均对患者跌倒恐惧有影响。结论:年龄、有跌倒史、平衡、移动能力及下肢运动功能是导致脑卒中患者跌倒恐惧的主要因素,针对脑卒中患者跌倒恐惧的主要因素提出针对性的护理干预措施,降低跌倒恐惧的发生率。     

老年人跌倒恐惧的研究进展

明确老年人跌倒恐惧的概念,阐述跌倒恐惧给老年人带来的不良后果并分析其影响因素,为老年人制定有效的干预措施提供理论基础。     

住院老年人跌倒的预防教育

目的了解医院内老年人跌倒的状况，以更有效地进行预防跌倒的教育。方法以查阅病历、访谈和实地观察跌倒环境获取资料，回顾分析1995～2004年在住院期间发生跌倒的老年人共40例。描述跌倒者的年龄、原有疾病、跌倒发生时间的分布，以厦当时是否有人在场、跌倒地点、跌倒与活动的关系等。结果跌倒者以高龄老人居多，老年痴呆、老年精神病、脑梗塞者较多；均发生在室内，在患者独处时发生；跌倒与活动密切相关。无论是否有肢体活动不便，能否自行活动，老年人均存在跌倒的危险。跌倒不仅发生在活动频繁的日间，夜间跌倒例数几乎与日间相同。跌倒后绝大部分发生不同程度损伤。结论老年人群是发生跌倒的高危人群，尤其是高龄老年人；预防教育需在对老年人反复强化教育的基础上，对他们的照护者加强教育；为减少老年人跌倒的发生，应在保持老年人自主能动性的前提下，适量限制老年人、特别是高龄老人的活动范围。老年人的居住休养环境应更适合老年人活动的需要，安装安全设施。对缺乏依从性的老年人应要求其签署跌倒发生危险的知情同意书，以避免不必要的医疗护理纠纷。     

Fear of falling in older adults: a guide to its prevalence, risk factors, and consequences.

Fear of falling, defined as a lack of self-confidence that one may avoid falls while doing everyday activities, may have serious consequences for elderly people. This article examines the prevalence, risk factors, and consequences of fear of falling in the elderly population; methods for assessing those fears; and suggests evidence-based interventions. Incorporating successful strategies into programs to reduce falling can result in improved patient outcomes as well as decreased healthcare utilization and costs.     

Fear of falling and its relationship with anxiety, depression, and activity engagement among community-dwelling older adults

OBJECTIVE. This study examined (1) the relationship of fear of falling to depression, anxiety, activity level, and activity restriction and (2) whether depression or anxiety predicted fear of falling, activity level, activity restriction, or changes in activity level. METHOD. We administered the Survey of Activities and Fear of Falling in the Elderly; the Geriatric Depression Scale-30; and the Hamilton Anxiety Scale, IVR Version, during a one-time visit to 99 community-dwelling adults ≥55 yr old. RESULTS. We found significant relationships between (1) fear of falling and depression, anxiety, and activity level; (2) depression and anxiety; and (3) activity restriction and depression. Activity level was negatively correlated with activity restriction, fear of falling, depression, and anxiety. Anxiety predicted both fear of falling and activity level. Both anxiety and depression predicted activity restriction because of fear of falling and for other reasons. CONCLUSION. Occupational therapy practitioners should consider screening their older adult clientele for fear of falling, anxiety, and depression because these states may lead to fall risk and activity restriction.     

What is the Relationship Between Fear of Falling and Gait in Well-Functioning Older Persons Aged 65 to 70 Years?

Rochat S, Büla CJ, Martin E, Seematter-Bagnoud L, Karmaniola A, Aminian K, Piot-Ziegler C, Santos-Eggimann B. What is the relationship between fear of falling and gait in well-functioning older persons aged 65 to 70 years?

Objective

To investigate the association between fear of falling and gait performance in well-functioning older persons.

Design

Survey.

Setting

Community.

Participants

Subjects (N=860, aged 65-70y) were a subsample of participants enrolled in a cohort study who underwent gait measurements.

Interventions

Not applicable.

Main Outcome Measures

Fear of falling and its severity were assessed by 2 questions about fear and related activity restriction. Gait performance, including gait variability, was measured using body-fixed sensors.

Results

Overall, 29.6% (210/860) of the participants reported fear of falling, with 5.2% (45/860) reporting activity restriction. Fear of falling was associated with reduced gait performance, including increased gait variability. A gradient in gait performance was observed from participants without fear to those reporting fear without activity restriction and those reporting both fear and activity restriction. For instance, stride velocity decreased from 1.15±.15 to 1.11±.17 to 1.00±.19 m/s (P<.001) in participants without fear, with fear but no activity restriction and with fear and activity restriction, respectively. In multivariate analysis, fear of falling with activity restriction remained associated with reduced gait performance, independent of sex, comorbidity, functional status, falls history, and depressive symptoms.

Conclusions

In these well-functioning older people, those reporting fear of falling with activity restriction had reduced gait performance and increased gait variability, independent of health and functional status. These relationships suggest that early interventions targeting fear of falling might potentially help to prevent its adverse consequences on mobility and function in similar populations.     

Risk factors for falls among the community-dwelling elderly in Korea

Community-based centres were surveyed to determine the frequency of and risk factors for falls among elderly Koreans. We examined fall-related risk factors, including physiological and physical health, psychosocial functions, self-reported physical capacity and activity, vision, and the use of medication, among 351 elderly people aged 65 years or older, with ambulatory. Forty-two per cent of elderly Korean subjects reported at least one episode of falling in the previous 12 months, 38% of whom had consequences that required either the attention of a physician or hospitalization. Factors significantly associated with an increased risk of falling were a restricted activity during the previous five years (adjusted OR 1.3), use of alternative therapy (adjusted OR 2.7), low knee flexor and extensor-muscle strength (adjusted OR 1.21 and 1.20), and poor balance with closed eyes (adjusted OR 8.32). We conclude that falls among older persons living in the community are common in Korea and that indicator of bad health and frailty or variables directly related to neuromuscular impairment are significant predictors of the risk of falling.     

Free Fatty Acid Receptor 1 (FFAR1) as an Emerging Therapeutic Target for Type 2 Diabetes Mellitus: Recent Progress and Prevailing Challenges

The free fatty acid receptor 1 (FFAR1/GPR40) amplifies glucose‐dependent insulin secretion; therefore, it has attracted widespread attention as a promising antidiabetic target. Current clinical proof of concept also indicates that FFAR1 agonists achieve the initially therapeutic endpoint for the treatment of type 2 diabetes mellitus (T2DM) without the hypoglycemic risk. Thus, many pharmaceutical companies and academic institutes are competing to develop FFAR1 agonists. However, several candidates have been discontinued in clinical trials, often without reporting the underlying reasons. Herein, we review the challenges and corresponding strategies chosen by different medicinal chemistry teams to improve the physicochemical properties, potency, pharmacokinetics, and safety profiles of FFAR1 agonists, with a brief introduction to the biology and pharmacology of related targets.     

Association between exercise and fear of falling in community-dwelling elderly Koreans: results of a cross-sectional public opinion survey

Lim J-Y, Jang S-N, Park W-B, Oh MK, Kang EK, Paik N-J. Association between exercise and fear of falling in community-dwelling elderly Koreans: results of a cross-sectional public opinion survey.

Objective

To investigate the association between habitual exercise and fear of falling in an older Korean population.

Design

Cross-sectional study conducted in a population-based sample of an urban city.

Setting

Urban city in South Korea.

Participants

Randomly sampled older Korean people (N=828; aged ≥65y) living in a typical urban city located in South Korea.

Intervention

Standardized telephone interview.

Main Outcome Measures

Data on exercise habits, history of falls during the previous year, and fear of falling were obtained using a random digit dialing telephone survey method. Multiple linear regression and multiple logistic regression analyses were used to examine the association between exercise habits and the fear of falling.

Results

The incidence of falls in the study cohort was 13%, and the prevalence of the fear of falling was 67.4% (47.6% in men and 80.8% in women). About 30% of those that expressed a fear of falling stated that this was the cause of their limited activity. Older men and women who exercised regularly showed a similar level of fear of falling, but they were less likely to experience fear-related activity restriction than nonexercisers.

Conclusions

A regular exercise habit was found to be inversely associated with fear-related activity restriction regardless of fall experience among older Korean men and women.     

Schmerz und Bewegungsangst im Alter

According to evidence-based guidelines a physically activating therapy approach in older chronic pain patients is necessary for the preservation of autonomy. Often the elderly are not easy to motivate for this because of inappropriate attitudes, low self-efficacy, fear of pain and fear of falling. The latter might be more important for self-induced restriction of activity in older pain patients than fear avoidance beliefs known from pain research. The fear of caregivers concerning pain and falls can also lead to physical restrictions in the elderly. The underlying diseases and drug effects have to be borne in mind in exercise-oriented therapy. It seems necessary to design special therapy elements for all national care sectors using age-specific motivation strategies and to assure an interdisciplinary cooperation.     

Balance training in the intervention of fall risk in elderly with diabetic peripheral neuropathy: A review

Diabetic peripheral neuropathy (DPN) was the most common complications of elderly diabetic, which could contribute to an increased risk of falling. Despite the increased prevalence of elderly diabetic, high risk of falls and serious consequences of falls in elderly with DPN, It is necessary to adopt means of reducing the risk of falls in elderly with DPN. Impaired balance in the elderly with DPN was the most important risk factor of increasing falls. This review will introduce the epidemiology of falls in elderly with DPN, analysis the reasons for high risk of falls in elderly with DPN, provide a review of the development of balance training in the intervention of fall risk in elderly with DPN and offer recommendations to medical personnels on how to provide an efficient balance training for elderly with DPN.     

临床护理路径在预防住院老年患者跌倒中的应用

目的：探讨临床护理路径管理模式在预防住院老年患者跌倒管理中的实施效果。方法：应用＂住院患者跌倒危险因素评估、监控表＂对60岁以上的住院患者进行跌倒危险性评估,筛选出跌倒高危患者205例,采用临床护理路径管理模式对患者进行护理干预,防止住院期间意外跌倒。结果：205例跌倒高危患者在住院期间发生跌倒1例,发生率为0.49%,跌倒率由2011年的2.15%下降到0.49%。结论：采取临床护理路径管理模式进行护理干预,能有效预防老年患者意外跌倒的发生。     

Fear of falling as seen in the Multidisciplinary falls consultation

Fear of falling may be as debilitating as the fall itself, leading to a restriction in activities and even a loss of autonomy.ObjectivesThe main objective was to evaluate the prevalence of the fear of falling among elderly fallers. The secondary objectives were to determine the factors associated with the fear of falling and evaluate the impact of this fear on the activity “getting out of the house”.Patients and methodProspective study conducted between 1995 and 2006 in which fallers and patients at high risk for falling were seen at baseline by the multidisciplinary falls consultation team (including a geriatrician, a neurologist and a physical medicine and rehabilitation physician) and then, again 6 month later, by the same geriatrician. The fear of falling was evaluated with a yes/no question: “are you afraid of falling?”.ResultsOut of 635 patients with a mean age of 80.6 years, 502 patients (78%) expressed a fear of falling. Patients with fear of falling were not older than those who did not report this fear, but the former were mostly women (P < 0,001), who experienced more falls in the 6 months preceding the consultation (P = 0.01), reported more frequently a long period of time spent on the floor after a fall (P < 0.001), had more balance disorders (P = 0.002) and finally, were using more frequently a walking technical aid (P = 0.02). Patients with fear of falling were not going out alone as much as the fearless group (31% vs 53%, P < 0.0001). Eighty-two percent of patients in the fearful group admitted to avoiding going out because they were afraid of falling.ConclusionThe strong prevalence of the fear of falling observed in this population and its consequences in terms of restricted activities justifies systematically screening for it in fallers or patients at risk for falling.