天津、唐山养老机构老年人跌倒现况及其影响因素研究

目的 分析天津、唐山两地养老机构老年人发生跌倒的现况及其影响因素,为采取有效措施减少跌倒发生提供理论依据。方法 采用便利抽样法,选取唐山市和天津市8所养老机构内490位老年人为研究对象,调查其在调查日前过去一年内发生跌倒的情况。采用一般资料调查表、Barthel指数、Morse跌倒评估量表和焦虑自评量表收集资料。采用x2检验或Fisher确切概率法进行比较。采用logistic回归分析养老机构老年人发生跌倒的影响因素。结果 223位（45.5%）老年人在调查日前一年内发生跌倒。多因素分析结果显示,年龄90~95岁（x2=4.744,P=0.029）、是否害怕跌倒（x2=14.769,P＜0.001）、跌倒风险（x2=94.526,P＜0.001）、日常生活轻度依赖（x2=6.691,P=0.010）、护理人员对老年人进行跌倒评估（x2=12.613,P＜0.001）和经常提醒老年人注意预防跌倒（SymbolcA@²=18.828,P＜0.001）是跌倒发生的影响因素。结论 养老机构老年人跌倒发生率较高,可通过进行跌倒风险评估等方式减少养老机构老年人跌倒的发生。     

苏州市某社区居家老年人跌倒危险因素分析

目的 探讨苏州市某社区居家老年人跌倒现状及危险因素,为社区跌倒预防工作提供参考.方法 采用方便抽样的方法,于2018年4—7月选取苏州市某社区60岁及以上居家养老的375名老年人为研究对象,采用Logistic回归模型分析跌倒的危险因素.结果 65名居家老年人在一年内发生过跌倒,发生率为17.33％,午饭后到晚饭间是老...     

Falls and associated factors in institutionalized elderly people in Pelotas (RS, Brazil)

The ageing of the population generates interest among health professionals, because of its importance for health. A cross-sectional study was carried out including institutionalized subjects aged over 65 from Pelotas (RS, Brazil). The aim was to investigate the prevalence of falls and associated factors. The prevalence of falls was 33.5%; the most frequent place in which falls occurred was the bedroom (37%). Of all falls, 16.9% resulted in a fracture. Approximately 70% of the falls took place at the institution in which the subjects live. Ankles and hips were the most frequently anatomic sites fractured (33,3%). The prevalence of falls among the elderly was high and the consequences of such falls are worrying. Prevention strategies by healthcare professionals and managers are urgently needed in order to minimize the burden of falls and thus enhance the quality of life of institutionalized elderly people.     

Does mortality of the aged increase with the number of falls? Results from a nine-year follow-up study

The objective of the study was to examine the predictive effect of prospectively registered falls on survival within a randomly selected group of elderly women. A longitudinal study, with 9 years follows up after 1 year prospective fall registration was designed. Persons age 75 or more living in the community. A total of 300 Norwegian women; mean age was 80.8 participated in the study. Base-line registrations of health, functioning and medication were made. Falls which occurred during a 1-year period after baseline were registered as well as the date of death within a 9-year period after the end of the fall registration period. Half of the women reported one or more falls (1–11). Eighty-six women (28.7%) experienced only one fall and 65 (21.7%) had at least two. During the 9-year follow-up period, 41.7% died. Cox regression analyzes demonstrated that frequent falling, old age and a self-reported worsening of health were significantly associated with mortality during the follow-up period. Their relative risks of death when experiencing at least two falls was 1.6 (95% CI 1.1–2.4), P = 0.04, when compared with no falls. Older fallers appear to have markedly increased mortality. Since falls are common among elderly people, this is a relevant fact for public health policy. Increasing age, poor self-rated health and high frequency of falls predict independently mortality in our 9 years follow up study. Because women represent the largest proportion of the elderly and falls are amendable, fall preventive may have the potential for significant impact on increasing year of life.     

上海市闸北区社区独居老人居家致跌环境调查

目的通过对社区老年人居家环境进行安全性评估,促进居家致跌危险环境改造和降低老年人跌倒的发生提供依据。方法对上海市某社区2008年8月1日—2009年8月1日期间全部80岁以上独居老人共395户、481人进行居家致跌危险环境的入户评估和老年人跌倒情况回顾性调查。结果跌倒发生率为17.05%,发生次数发生率为24.32%,其中发生2次以上跌倒占32.93%,因跌倒住院占5.19%。居家致跌环境主要包括在地面或通道未使用防滑地砖(38.23%)、室内照明亮度不够(47.85%)、浴缸(淋浴房)未使用防滑垫(62.78%)和浴缸(淋浴房)旁未安装扶手(70.89%)等。结论独居老人是发生跌倒的高危人群,居家致跌环境因素增加了老人跌倒发生的风险,开展有针对性的居家危险环境评估其意义重大。     

马鞍山市社区老年人跌倒现况分析

目的 了解马鞍山市社区老年人跌倒分布特征及影响因素,为制定社区老年人跌倒干预措施提供理论依据。方法 采用整群随机抽样的方法,选择居住在马鞍山市社区的60岁以上老年人进行入户访谈,调查过去1年的跌倒状况。 结果 3476名社区老年人中过去1年跌倒发生（人）率为10.0%,重复跌倒发生（人）率为3.1%;跌倒发生（次）率为18.0% ,重复跌倒发生（次）率为7.9%。1年内跌倒发生总体呈上升趋势,12月份达到高峰,1天中跌倒主要发生在6[DK]∶00~11[DK]∶00,14[DK]∶00~18[DK]∶00两个时间段;住所外跌倒发生率略高于住所内,公路/小区道路是跌倒最常发生的地点;在全部跌倒人群中,跌倒受伤率为57.9%,就医率为30.4%。有序logistic结果显示,较高的年龄、患慢性病、有疼痛、与日常生活能力正常相比日常生活能力障碍、处于抑郁状态的老年人更容易跌倒。结论 社区老年人跌倒问题不容忽视,应根据老年人跌倒特点开展有针对性的预防措施。     

Falls in older people

Thirty per cent of people aged over 65 fall each year in the UK. This number increases to more than 60% in those in care homes, illustrating the contextual nature of falls. The social consequences (apart from any injury) are considerable, with fear of falling among the most common. Fear of falls reduces the patient's quality of life and increases dependency. This has a significant knock-on effect for social and community care. For GPs, the frequency of falls presenting depends on the nature of the practice and the environment. But if you ask patients, you will find falls. As a consequence, they form part of the single assessment process (SAP) introduced in the national service framework for older people, which is used to determine a patient's health and social care needs. To manage falls more effectively, this contribution assesses how Southwark and Lambeth Integrated care pathway for older people with falls (SLIPS Project) has been developed as a fully integrated pathway linking acute care with primary, community and social care.     

Home hazards and falls in the elderly: the role of health and functional status.

OBJECTIVES. This study was undertaken to determine whether vigorous and frail older people who identify environmental hazards in their homes have an increased risk for falls. METHODS. A 1-year prospective study was conducted among 266 female and 59 male community-dwelling volunteers aged 60 to 93 years who had fallen at least once during the previous year. Composite measures of home safety and of frailty were derived using principal components analysis. Participants were divided into vigorous and frail groups, and associations between baseline home safety measures and falls at home over the follow-up year were compared between the two groups. RESULTS. Frail individuals were more than twice as likely as vigorous individuals to fall during follow-up (rate ratio [RR] = 2.24; 95% confidence interval [CI] = 1.54, 3.27). In the study group as a whole, falls were not strongly associated with the presence of home hazards. However, when compared with vigorous older persons living with fewer home hazards, vigorous older persons living with more home hazards were more likely to fall. The increased risk for falls among vigorous elderly was limited to falls where home hazards were present. By contrast, living with more home hazards was not associated with increased likelihood of falls among frail older persons. CONCLUSIONS. While frail older persons experience higher overall fall rates, vigorous older persons should not be overlooked in fall prevention projects.     

2018年武汉市老年人跌倒伤害及其影响因素

目的探讨武汉市老年人跌倒现状和影响因素,为预防老年人跌倒提供科学依据。方法通过问卷调查和健康体检收集2018年武汉市65岁以上老年人免费体检数据387 476条,采用SAS 9.4软件进行描述性分析、χ^2检验和多因素Logistic回归分析。结果 2018年老年人跌倒报告率为3.44%,城市(4.42%)高于农村(2.39%),女性(4.22%)高于男性(2.47%);家中是老年人跌倒的好发地点(占46.48%);最常见的跌倒伤害性质为扭伤/拉伤(占31.07%);多因素分析表明,跌倒的主要危险因素有女性,轻中度依赖的生活自理能力,运动能力减弱-双手不能放脑后、不能捡起地上物品,骨关节疾病,眼部疾病,脑卒中(均有P<0.05)。结论 2018年武汉市65岁以上老年人过去一年内跌倒伤害的报告率为3.44%,生活自理能力减弱、运动能力减弱、患骨关节疾病、眼部疾病、脑卒中是老年人跌倒的重要危险因素。     

社区老年人跌倒及危险因素调查

目的对社区老年人跌倒情况及危险因素进行调查,为社区干预提供科学依据。方法采用随机整群抽样方法,对某街道随机抽取的3 440户中的60岁及以上所有老年人在2007年1月1日—12月31日间发生跌倒的情况进行回顾性调查。结果 60岁以上的1 967名调查对象中,跌倒伤害发生率为2.54%;其中男性跌倒发生率为1.68%,女性跌倒发生率为3.35%。61.54%跌倒发生在家中;57.69%跌倒是因地面潮湿和地面不平等环境因素造成的。年龄、平衡失调、步态不稳、身体状况差、慢性病等是老年人跌倒的主要危险因素(P0.05)。结论跌倒受老年人的身心健康和环境因素共同影响,加强对跌倒危险因素的干预是今后老年人预防跌倒的工作重点。     

慢性病对中老年人跌倒伤害影响的队列研究

目的:分析慢性病对我国中老年人跌倒伤害风险的影响。方法:数据来源于中国健康与养老追踪调查（CHARLS）,以2011年基线调查募集的13 670名≥45岁中老年人作为研究对象并追踪至2018年,其中45~59岁中年人7 443例（54.45%）,≥60岁老年人6 227例（45.55%）。采用Cox比例风险模型分析不同...     

Falls among institutionalized elderly in Alexandria

Falls are a common geriatric problem causing considerable morbidity, mortality, and affecting the quality of life of many elderly people. A cross sectional study was conducted to determine the prevalence and risk factors of falls among elderly people living in geriatric institutions in Alexandria. The total sample included 103 elderly females and 62 elderly males from six institutions. All participants were subjected to interviewing questionnaire to collect data about history, circumstances, outcome of falls, previous falls and history of diseases and drug intake It included also data about activities of daily living. Anthropometric measurements, blood pressure, postural hypotension assessment, complete physical examination and Tinetti scale for balance and gait could be completed for a sub-sample. The prevalence of falls was 32.1%. Most of the falls occurred during the daytime (77.4%), mainly in the bedroom or in the way from bed to bathroom (37.7% each). The most likely causes were slip/trip (41.5%) followed by dizziness/vertigo (32.1%). Fractures occurred in 20.8% of falls. Advanced age (70-79, 80 years and above), history of three or more falls, history of disability from previous falls, history of visual problem, history of cardiac and antihypertensive drug use, and mild impairment of balance and gait were significant risk factors for falls in the univariate analysis. All these factors except for the impairment of balance and gait were also significant predictors of falls in the multivariate analysis.     

重庆市老年人多次跌倒发生率及相关因素分析

目的 了解重庆市65岁及以上老年人过去1年多次跌倒发生率及相关因素,为开展干预工作提供建议.方法 在4个区县采用多阶段分层整群随机抽样抽取65岁及以上老年人进行问卷调查.多次跌倒发生率的比较采用x2检验,多次跌倒发生的相关因素采用多因素logistic回归分析.结果 共计调查1607人,平均年龄(72.36±6.27)...     

2002-2015年上海市浦东新区老年人意外跌落死亡流行特征及趋势分析

目的 了解2002-2015年浦东新区老年人意外跌落死亡的流行特征及其趋势,为制定相应的干预措施提供依据。方法 对2002-2015年浦东新区老年人意外跌落死亡资料进行流行病学分析,采用死亡率、标化死亡率、年度变化百分比(APC)、不同年龄组间变化百分比(PC)等指标对死亡情况进行分析。结果 浦东新区2002-2015年期间60岁以上老年人意外跌落粗死亡率为54.95/10万,标化死亡率为36.70/10万,是浦东新区老年人首位意外伤害死因,占45.74%。14年间老年人意外跌落死亡率呈现逐年下降的趋势(APC=-3.87, Z=-6.41, P<0.001),随年龄增长呈现上升趋势(PC=18.57%, Z=13.45, P<0.001);老年女性意外跌落死亡率高于男性(Z=-10.94, P<0.001),男女意外跌落死亡率均呈下降的趋势(APC_男性=-2.26%, Z_男性=-4.07, P=0.002; APC_女性=-4.70%, Z_女性=-5.68, P<0.001);郊区老年人意外跌落死亡率高于城区(Z=2.32, P=0.022),城郊老年人口意外跌落死亡率均呈下降趋势(APC_城区=-3.14%, Z_城区=-4.72, P<0.001; APC_郊区=-6.14%, Z_郊区=-5.94, P<0.001)。结论 2002-2015年浦东新区老年人意外跌落死亡呈现逐年降低趋势,郊区老年人意外跌落死亡值得关注,应采取进一步的干预措施。     

The construction of a patient record-based risk model for recurrent falls among elderly people living in the community

BACKGROUND: Predictive models of fall risk in the elderly living in the community may contribute to the identification of elderly at risk for recurrent falling. OBJECTIVES: Our aim was to investigate occurrence, determinants and health consequences of falls in a community-dwelling elderly population and the contribution of data from patient records to a risk model of recurrent falls. METHODS: A population survey was carried out using a postal questionnaire. The questionnaire on occurrence, determinants and health consequences of falls was sent to 2744 elderly persons of 70 years and over, registered in four general practices (n = 27 000). Data were analysed by bivariate techniques and logistic regression. RESULTS: A total of 1660 (60%) responded. Falls (> or =1 fall) in the previous year were reported by 44%: one-off falls by 25% and recurrent falls (> or =2 falls) by 19%. Women had significantly more falls than men. Major injury was reported by 8% of the fallers; minor injury by 49%. Treatment of injuries was by the GP in 67% of cases. From logistic regression, a risk model for recurrent falls, consisting of the risk factors female gender, age 80 years or over, presence of a chronic neurological disorder, use of antidepressants, problems of balance and sense organs and complaints of muscles and joints was developed. The model predicted recurrent falls with a sensitivity of 64%, a specificity of 71%, a positive predictive value of 42% and a negative predictive value of 86%. CONCLUSION: A risk model consisting of six variables usually known to the GP from the patient records may be a useful tool in the identification of elderly people living in the community at risk for recurrent falls.     

Falls Among the Community-living Elderly People in Hong Kong: A Retrospective Study

Purpose

To examine the base rate of falls for a group of community-living elderly people in Hong Kong.

Methods

This was a retrospective cross-sectional study of 554 elderly people aged 65 years or above living in various geographical regions of Hong Kong, who had completed assessments at a community centre over a period of 4 months. Participants were recruited by convenience sampling and stratified by age range according to the distribution in Hong Kong population. They were asked to report on their fall history for a period of the 12 months before joining the study.

Results

Of all the participants, 111 reported having fallen during the preceding 12 months. The fall rate was 29%, and the 1-year prevalence of falls was 20%, dropping to 6.3% for two or more falls. Of all the falls, 47.7% occurred indoors whereas 52.3% occurred outdoors. Results showed female gender, Timed Up & Go Test, self-reported history of upper limb fracture, an intake of four or more types of medication, receiving rehabilitation services, and living with a couple only were independent predictors for fallers with at least one fall. There were no significant differences between the number of near-miss experienced by fallers and nonfallers in the past 12 months.

Conclusion

We determined the base rate of falls for a group of community-living elderly people of Hong Kong. Retrospective methods, which ask elderly people living in a community to recall their falls, may be used to identify risks preceding falls and to facilitate early intervention.     

2010 - 2016年江苏省老年人群意外跌倒死亡流行特征

目的 了解江苏省≥60岁老年人群意外跌倒死亡的流行特征和寿命损失情况,为制定我省预防跌倒伤害干预措施提供科学依据。方法 收集全国疾病监测系统中2010 - 2016年江苏省死因监测数据,计算城乡、不同性别、不同年龄的意外跌倒死亡率及疾病负担指标:潜在减寿年数（Potential Years of Life Lost, PYLL）、潜在减寿率（Potential Years of Life Lost Rate, PYLLR）和平均减寿年数（Average Years of Life Lost, AYLL）。年度变化百分比用于检验死亡率的时间变化趋势。结果 2010 - 2016年,江苏省60岁以上老年人口比例逐年增加。意外跌倒是我省老年人群因意外死亡的首位原因。老年人意外跌倒死亡率随年龄增加而升高。男、女和农村居民意外跌倒死亡率都呈逐年上升趋势（标化t男 = 9.260,t女 = 11.161,t农村 = 13.931,三者P＜0.001）。男性意外跌倒死亡的PYLL、PYLLR和AYLL都高于女性,农村居民总体高于城市居民。结论 老年跌倒已成为江苏省不容忽视的公共卫生问题,在农村更为严峻。应将跌倒干预工作作为江苏省老年人伤害防控的优先领域。     

Fall-risk screening test: a prospective study on predictors for falls in community-dwelling elderly

This large prospective cohort study was undertaken to construct a fall-risk model for elderly. The emphasis of the study rests on easily measurable predictors for any falls and recurrent falls. The occurrence of falls among 1285 community-dwelling elderly aged 65 years and over was followed during 1 year by means of a "fall calendar." Physical, cognitive, emotional and social functioning preceding the registration of falls were studied as potential predictors of fall-risk. Previous falls, visual impairment, urinary incontinence and use of benzodiazepines were the strongest predictors identified in the risk profile model for any falls (area under the curve [AUC] = 0.65), whereas previous falls, visual impairment, urinary incontinence and functional limitations proved to be the strongest predictors in the model for recurrent falls (AUC = 0.71). The probability of recurrent falls for subsequent scores of the screening test ranged from 4.7% (95% Confidence Interval [CI]: 4.0-5.4%) to 46.8% (95% CI: 43.0-50.6%). Our study provides a fall-risk screening test based on four easily measurable predictors that can be used for fall-risk stratification in community-dwelling elderly.     

广东省老年人跌倒及其影响因素和平衡能力受损现况

  目的  调查广东省社区老年人跌倒和平衡能力受损现状及跌倒影响因素。  方法  采用多阶段分层整群随机抽样的方法进行抽样调查,共有5 503名≥60岁老年人纳入分析。采用χ2检验分析老年人跌倒发生率和平衡能力受损率在不同特征老年人之间的差异,采用多因素Logistic回归分析模型分析跌倒的影响因素。  结果  本研究中老年人过去1年的跌倒发生率为11.90%,平衡能力受损率为58.37%。跌倒和平衡能力受损情况在女性、农村、文盲、无配偶和独居的老年人中较为常见(均有P＜0.05)。多因素分析显示,女性跌倒的危险性较男性高,跌倒发生情况随年龄的增加而愈发严重。农村老年人跌倒危险性高于城市老年人。老年人在家走动或做家务时最常发生跌倒(35.11%),因跌倒造成擦伤/挫伤、骨折、扭伤/拉伤、脑震荡/脑挫裂伤和其他受伤类型的比例分别为55.77%、22.22%、17.09%、1.07%和3.85%。  结论  广东省社区老年人在过去1年内发生跌倒的情况较多,平衡能力受损现状严重,应加强对老年人的防跌倒健康宣教和以家庭防护为主的综合干预措施。     

Falls and Fall-Related Injuries Among the Elderly: A Survey of Residential-Care Facilities in a Swedish Municipality

Injurious falls among the elderly are an increasing public-health problem in Sweden. One group particularly vulnerable to falls consists of elderly people living in residential-care facilities. The purpose of this study was to investigate the extent to which falls lead to injury within a defined population of elderly people in institutionalized care. All the elderly persons living in residential-care facilities in an urban Swedish municipality during the year 1997 (n = 469 institutional places). Falls and fall-related injuries were registered over a one-year period. Data were gathered by personnel at the time of the falls, using a form specifically designed for surveillance purposes. Of the 865 falls reported during the study period, 375 were among men, with an average age of 82 years, and 490 among women, with an average age of 85 years. Men were subject to falling to a greater extent than women. The most common location was the individual's own bedroom. Injuries were incurred in approximately one in four falls, and the head was the body part most frequently injured. Only 24 falls (2.8%) resulted in a fracture, of which 18 were hip fractures. Although elderly people living in residential-care facilities fall fairly often, serious injuries, in the form of fractures, are incurred to a relatively limited extent.