Falls and fall prevention in the elderly: the Jamaican perspective

Falls in the elderly may precipitate adverse physical, medical, psychological, social and economic consequences and are an issue of concern in both developed and developing countries. In Jamaica, there are no epidemiological studies on falls in the elderly though there is evidence to suggest that it is an issue that warrants some attention. This paper, through the use of quantitative and qualitative methods, provides insights on falls in the elderly in Jamaica. Through literature reviews, review of medicals records, and conducting focus group interviews, perspectives were gleaned on falls in elderly persons in Jamaica. Contributory risk factors and perceptions, and costs were explored, as were any existing fall prevention policies or policy thrusts. The emerging picture is that falls are not a rare occurrence among older persons in Jamaica and extrinsic factors such as poor road surfaces, poorly constructed steps and poor design of public transportation vehicles are factors that contribute to falls. Similarly, intrinsic factors related to co-morbid conditions such as hypertension, diabetes mellitus and sensory impairment appear to also contribute to increased risk of falling.     

Falls

An elderly person experiencing recurrent falls is at risk. He is at risk from injury sustained during the fall and at risk from the complications of immobility resulting from loss of confidence. Urgent early assessment and identification of causative and risk factors is essential.     

Falls: A modifiable risk factor for the occurrence of hip fractures in the elderly

The objective of the study was to examine the clinical and demographic features of patients with hip fractures presenting to the Accident and Emergency Department, the University Hospital of the West Indies (UHWI). The study involved all patients with hip fractures registered in the Trauma Registry at the UHWI between January 1, 1998 and December 31, 2001. They were assessed retrospectively for age, gender, associated extrinsic and intrinsic factors, cause of the fall, location when fracture occurred and the site of the femur that was fractured. One hundred and fifty-two persons were identified There were one hundred and eleven women and forty-one men. Seventy-eight per cent of the falls occurred in the over sixty-five-year age group. Ninety per cent of the patients had a fall associated with their fracture. Most of the falls occurred at the patients' homes. This study indicated that falling at home was the commonest associated factor for the occurrence of hip fractures and preventive measures may lead to reductions in the frequency of hip fractures seen in the emergency room.     

Falls in the elderly--clinician's approach

Fall is an involuntary event producing a change in posture resulting in the individual adopting an unplanned supine position. Globally more than one-third of persons 65 years of age or older fall each year and in half of such cases the falls are recurrent. Several predisposing factors for such falls have been recognised like age related changes in posture control, reduced visual acuity, anxiety, drugs, environmental hazards and underlying neurological diseases. It is the interplay of predisposing and precipitating factors that really matter and not exactly a single cause. Evidence based interventions have been suggested from recent clinical trials and certain preventive guidelines are present to reduce the rate of falling, provided a periodic targeted approach is followed.     

住院患者跌倒及坠床的原因及护理干预研究

目的 研究住院患者跌倒及坠床的原因及护理干预措施.方法 选择我院接收的50例住院患者,分析跌倒及坠床的原因,提出对症护理干预.结果 引起跌倒坠床的因素是自行上下床、坐在床边、床旁取物、体位改变、自行行走及倚墙站立;伤及部位是头面部、骶骨部、蛛网膜下腔出血及其他.结论 根据住院患者跌倒及坠床原因提供对症护理干预能稳定病情...     

强直性肌营养不良患者的跌倒及绊倒

背景：补骨脂素联合长波紫外线（PUVA）是治疗早期蕈样肉芽肿病（MF）的标准疗法。在PUVA疗法中应用8-甲氧补骨脂素时，常发生不耐受反应，如恶心、呕吐及头痛。目的：研究5-甲氧补骨脂素是否可作为8-甲氧补骨脂素的安全有效的替代物应用于MF的PUVA治疗。方法：对1990-2004年间在作者所在医院接受PUVA（使用5-甲氧补骨脂素或使用8-甲氧补骨脂素作为初始单一疗法）的蕈样肉芽肿患者进行回顾性调查并制成统计图表。14例患者[7例男性与7例女性；平均年龄70岁，极差51～82；国立癌症研究院疾病分期IA（n=6）及IB（n=8）]接受5-甲氧补骨脂素治疗，24例患者[21例男性与3例女性；平均年龄58岁，极差28～89；疾病分期IA（n=11），IB（n=12），liB（n=1）]接受8-甲氧补骨脂素治疗。结果：5-甲氧补骨脂素组14例患者中有12例（86％），8-甲氧补骨脂素组24例患者中有22例（92％）对PUVA产生完全反应。这两个完全反应患者亚群的PUVA治疗持续时间、治疗次数或UVA累积量无显著差异。无复发存活率[8％（1／12）vs23％（5／22）]或完全反应至复发时间[17个月（极差4～31）vs14个月（极差4～33）]也无显著差异。而且，在完全反应患者亚群中，应用5-甲氧补骨脂素或8-甲氧补骨脂素进行PUVA维持治疗也不影响其长期无复发状态[26％（9／34）]。结论：5-甲氧补骨脂素与8-甲氧补骨脂素在用于PUVA治疗MF时作用相当。     

维生素D与跌倒

老年人容易发生跌倒,在社区居住的>65岁的老年人中每年有30%～40%发生跌倒。与跌倒相关的并发症严重影响了老年人的生活质量。既往的荟萃分析得出:维生素D可以使跌倒的发生率降低22%,而最近的一些研究却得出了不同的结论。文章阐述了维生素D减少跌倒发生的可能机制,重点分析了维生素D与肌力及平衡能力的关系。对近年有关维生素D和跌倒的临床试验进行综述,旨在进一步明确维生素D预防跌倒的意义。     

Falls amongst institutionalised psycho-geriatric patients

Falls are common among the elderly patients in the psycho-geriatric wards and yet they have been understudied. A fall is a multi-factorial syndrome involving the patient and the environment. Psycho-geriatric patients who fall may suffer serious physical injuries that result in morbidity, further institutionalisation or even mortality. This study aims to examine the contributing factors to, and morbidity and outcome of falls among institutionalised psycho-geriatric patients so that preventive strategies can be refined. Data of patients who fell over a year's period in four psycho-geriatric wards were collected retrospectively and compared with those who had not fallen within the same period. The general profile of the psycho-geriatric patient who falls is one who is: above seventy-five years old; on three or more medications; and having recent changes in medication and mental status. About one in three fallers fell repeatedly. The rate of serious injury and mortality was low. In conclusion, while many factors are attributable to the common effects of aging and physical illnesses; psychotropic medication, change in mental state and specific environmental factors also play significant contributory roles to falls in this group of patients.     

Falls and fractures in patients with Alzheimer-type dementia

The prevention of fall-related injuries in patients with Alzheimer-type dementia (ATD) is hampered by an incomplete understanding of their causes. We studied falls and fractures in 157 ATD patients, including 117 with three-year follow-up. Initially all but one patient could walk; 31% reported falls. During follow-up, 50% either fell or became unable to walk. The fracture rate during follow-up (69/1000/y) was more than three times the age- and sex-adjusted fracture rate in the general population. Features of both ATD and comorbid conditions contributed to the risk of falls and fractures. In particular, patients who experienced toxic reactions to drugs on entry into the study were more likely to report they had fallen prior to entry (odds ratio, 4.9; 95% confidence interval, 1.78 to 13.3), and patients who wandered were more likely to sustain fractures (odds ratio, 3.6; 95% confidence interval, 1.25 to 10.4) during the follow-up period, including hip fractures for which the odds ratio of 6.9 (95% confidence interval, 1.66 to 28.6) was unexpectedly high. Preventive measures may be possible, including controlling wandering, avoiding toxic reactions to drugs, and treating comorbid illnesses.     

听力损失老年人跌倒的研究进展

全球老龄化程度不断加深的背景下,老年人听力损失的发病率越来越高。听力损失会限制老年人监测和感知空间方位的听觉线索能力,导致方向混乱,增加老年人跌倒的风险。本研究介绍了听力损失老年人跌倒的流行病学特征,阐述了其发生机制,包括神经病理学机制、感官剥夺机制、物理学机制,并通过梳理相关文献,总结了影响因素,包括年龄、性别、听力损失程度、听力损失性质、步态表现、助听设备的使用等,最后,提出听力损失老年人跌倒的防治对策。本研究发现,听力损失老年人跌倒发生情况占比增高,听力损失程度、年龄增长、老年女性激素水平改变、平衡能力下降、负性情绪等是听力损失老年人发生跌倒的危险因素,建议从助听设备使用和听觉康复训练、药物治疗、平衡能力评估和身体锻炼、心理干预4个方面对听力损失老年人跌倒进行防治,从而降低患者跌倒的发生率,保障其生活质量和生命安全。     

老年人认知功能和跌倒的关系研究

背景　跌倒既可直接造成伤害,又可导致害怕再次跌倒的心理状态,继而降低老年人的活动能力、灵活性和独立性。已有研究显示认知功能障碍可能增加跌倒的风险。然而,二者的因果关系并未完全阐明。目的　探讨中国老年人认知功能障碍和跌倒的关系,以期为跌倒或认知功能障碍的影响因素研究提供数据支撑。方法　2018年7—9月选取如皋长寿和衰老研究的子队列中1 692例老年人的认知功能和跌倒数据。根据改良长谷川痴呆量表（HDS-R）得分将老年人分为无认知功能障碍组（HDS-R得分>21.5分,890例）和认知功能障碍组（HDS-R得分≤21.5分,802例）。根据近1年（2015—2016年）跌倒发生次数将老年人分为无跌倒组（0次,1 316例）和跌倒组（≥1次,376例）。比较无认知功能障碍组与认知功能障碍组一般资料（2016年第1次随访数据）,无跌倒组与跌倒组一般资料、认知功能障碍发生情况;分析认知功能和跌倒的关联。结果　无认知功能障碍组与认知功能障碍组年龄、性别、职业、受教育程度、婚姻状况、吸烟状况、饮酒状况、BMI、自评健康状况比较,差异有统计学意义（P<0.05）。无跌倒组与跌倒组性别、受教育程度、婚姻状况、自评健康状况、认知功能障碍发生情况比较,差异有统计学意义（P<0.05）。Logistic回归分析结果显示,在调整了年龄、性别、职业、受教育程度、婚姻状况、吸烟状况、饮酒状况、BMI后,HDS-R得分≤21.5分情况〔OR=1.36,95%CI（1.01,1.84）〕、HDS-R得分每增加1分〔OR=0.96,95%CI（0.94,0.99）〕、HDS-R得分每增加1个标准差〔OR=0.77,95%CI（0.66,0.91）〕与跌倒有关（P<0.05）;在调整了年龄、性别、职业、受教育程度、婚姻状况、吸烟状况、饮酒状况、BMI、自评健康状况、高血压发生情况、糖尿病发生情况后,HDS-R得分每增加1分〔OR=0.97,95%CI（0.95,0.99）〕、HDS-R得分每增加1个标准差〔OR=0.81,95%CI（0.69,0.96）〕与跌倒有关（P<0.05）。结论　女性、文盲、目前没有婚姻伴侣、自评健康状况较差的老年人的认知功能障碍和跌倒的发生率较高,且老年人认知功能障碍与跌倒发生显著相关,提示认知功能障碍可能是跌倒发生的危险因素。因此,在评估老年人跌倒风险时,认知功能可以作为参考依据之一,及早识别认知功能障碍可能有利于跌倒的预防。