基于循证的老年人团体防跌倒奥塔戈运动方案的构建与实施

目的提高社区老年人运动效能。方法依据最佳证据,结合社区老年人运动问题分析,构建"基于循证的老年人团体防跌倒奥塔戈运动方案",用于32名社区老年人运动实践。实施5个月后评价效果。结果 29名社区老年人完成全程研究,其平衡能力、跌倒效能、体能水平、跌倒风险、满意度得分及总分显著优于运动方案实施前(均P0.01)。结论基于循证的团体实践方案可有效改善社区老年人平衡、体能能力,从而降低跌倒风险。     

住院老年患者跌倒警觉度现状及影响因素研究

目的 了解住院老年患者跌倒警觉度状况,并分析其影响因素,为制定针对性跌倒预防措施提供借鉴。方法 采用便利抽样法选取782例住院老年患者为调查对象,使用一般资料调查表、Morse跌倒评估表、Barthel指数、跌倒警觉度量表进行调查。结果 有效调查住院老年患者695例,住院老年患者跌倒警觉度得分为(62.67±12.34)分。多元线性回归结果显示,自理能力、是否害怕跌倒及知晓治疗用药易致跌倒是患者跌倒警觉度的影响因素(均P<0.05)。结论 住院老年患者跌倒警觉度较高,护理人员应结合患者跌倒警觉程度及影响因素,进行个性化的健康教育和安全指导,预防跌倒发生。     

住院老年患者跌倒警觉度现状及影响因素研究

目的 构建江西省三级甲等医院ICU护理安全管理指标体系.方法 通过文献资料法、质性研究法及德尔菲专家咨询法构建江西省三级甲等医院ICU护理安全管理指标体系.结果 专家的权威系数为0.8867,判断系数为0.8800.熟悉程度为0.8933;最终确定的江西省三级甲等医院ICU护理安全管理指标体系包括6项一级指标、14项二级指标、47项三级指标,各个指标的重要性赋值均数＞3.5、满分比＞0.20、变异系数＜0.25,2轮专家咨询的协调系数为0.263、0.273,经χ2检验,均P＜0.01.结论 构建的江西省三级甲等医院ICU护理安全管理指标体系具有较高的可靠性,可用于ICU护理安全管理评价.     

Effect of compliant flooring on impact force during falls on the hip.

Compliant flooring represents a promising but understudied strategy for reducing impact force and hip fracture risk due to falls in high-risk environments such as nursing homes, hospitals, gymnasiums, and senior centers. We conducted "pelvis release experiments" with young women (n=15) to determine whether floor stiffness influences peak hip impact force during safe, low-height falls. During the trials, we used a pelvic sling and electromagnet to lift and instantly release the participant from a height of 5 cm above a force plate, which measured the force applied to the hip region during impact. Trials were conducted for rigid floor conditions and with layers of ethylene vinyl acetate foam rubber overlying the floor that we regarded as firm (1.5-cm thick; stiffness=263 kN/m), semifirm (4.5-cm thick; stiffness=95 kN/m), semisoft (7.5-cm thick; stiffness=67 kN/m), and soft (10.5-cm thick; stiffness=59 kN/m). When compared to the rigid condition, peak hip impact force averaged 8% lower in the firm condition and 15% lower in the semifirm condition. Peak forces were not significantly different between the semifirm, semisoft, and soft floor conditions, indicating that a 4.5 cm-thick foam mat provides nearly the same force attenuation as a 10.5 cm-thick mat. These results support the need for laboratory experiments to measure the effect of floor stiffness on postural stability and for clinical trials to determine the effect of compliant flooring on hip fracture incidence in high-risk environments.     

目标管理对预防住院患者跌倒的作用

目的探讨目标管理对预防住院患者跌倒的可行性并评价其效果。方法遵循目标管理的基本原则及流程,即确定控制目标、制定现场检查追踪内容和评价标准、加强全员培训、追踪督导并及时反馈,对住院患者跌倒发生情况实施目标管理。评价目标管理前后住院患者跌倒发生率和护士对高风险患者管理正确率。结果目标管理后住院患者跌倒发生率为0.15%,显著低于基线值的0.20%(P0.01);护士对高风险患者管理正确率从管理前的33.33%~43.06%上升到管理后的84.72%~93.06%,差异有统计学意义(均P0.01)。结论目标管理能降低住院患者跌倒发生率,但在目标管理过程中,应做到科学设定目标值,定期评价管理效果并及时采取措施改进,达到持续质量改进目的。     

Non-syncopal falls in the elderly in relation to home environments

Methods of prevention of falls in the home may differ for healthy and frail individuals. We therefore sought to determine whether measures of health and functioning in older persons are more useful in predicting falls at home not involving home hazards (non-environmental falls) than falls at home related to home hazards (environmental falls), and whether these relationships differ among those who fell once and those who fell multiple times during follow-up. Data for this analysis are from a 1-year prospective cohort study of 325 community-dwelling volunteers aged 60–93 years who had fallen during the year before baseline. In general, associations were stronger between poor functional ability and non-environmental falls than between poor functional ability and environmental falls. Independent predictors of non-environmental first falls during follow-up included Parkinson's disease (adjusted odds ratio (AOR) 7.66, 95% confidence interval (95% CI) 1.15–51.1) and being home alone 10 or more hours per day (AOR 2.36, 95% CI 1.20–4.61); independent predictors of environmental first falls during follow-up included arthritis (AOR 2.60, 95% CI 1.32–5.09) and poor depth perception (AOR 0.73, 95% CI 0.59–0.89, for each unit increase in depth perception score). Also, associations between poor function and falls were generally stronger among participants who fell repeatedly than among individuals who fell only once during the follow-up year. In conclusion, poor function predisposes to non-environmental falls at home in older persons and, to a lesser extent, environmental falls in those who fall repeatedly. Certain functional characteristics such as poor depth perception may predispose to environmental falls to a greater extent than do other disabilities.     

HIV prevention metrics: lessons to be learned from contraception

IntroductionAs the range of effective HIV prevention options, including multiple biomedical tools, increases, there are many challenges to measuring HIV prevention efforts. In part, there is the challenge of varying prevention needs, between individuals as well as within individuals over time. The field of contraception faces many similar challenges, such as the range of prevention methods and changing contraceptive needs, and has developed many metrics for assessing contraceptive use at the program level, using frameworks that move beyond the HIV prevention cascade. We explore these similarities and differences between these two prevention fields and then discuss how each of these contraceptive metrics could be adapted to assessing HIV prevention.DiscussionWe examined measures of initiation, coverage and persistence. Among measures of initiation, HIV Prevention–Post Testing would be a useful corollary to Contraceptive Use–Post Partum for a subset of the population. As a measure of coverage, both Net Prevention Coverage and HIV Protection Index (modelled off the Contraception Protection Index) may be useful. Finally, as a measure of persistence, Person‐Years of HIV Protection could be adapted from Couple‐Years Protection. As in contraception, most programs will not reach 100% on HIV prevention metrics but these metrics are highly useful for making comparisons.ConclusionsWhile we may not be able to perfectly capture the true population of who would benefit from HIV prevention, by building off the work of the contraceptive field to use and refine these metrics, we can assess and compare HIV prevention over time and across programs. Furthermore, these metrics can help us reach global targets, such as the 2025 UNAIDS Goals, and reduce HIV incidence.     

预防患者跌倒APS规范化实践体系的构建及应用

目的构建预防患者跌倒规范化实践体系并探讨其应用效果。方法以"减少跌倒"为目标,从组织管理、评估与措施落实、质量监控、信息化建设等方面构建预防患者跌倒的评估(Assessment)、信息平台(Platform)、监管(Supervise)(下称APS)规范化实践体系,对该体系运行效果进行对比研究。结果预防患者跌倒APS规范化实践体系实施后,患者跌倒发生率较实施前显著降低,护士对患者跌倒风险评估的准确性、及时性、护理措施落实率实施较前显著提高(均P0.01)。结论构建预防患者跌倒APS规范化实践体系,可降低患者跌倒发生率,提高患者住院安全性及护士对患者跌倒风险管理的能力,从而提高护理质量。     

老年人跌倒警觉度研究进展

介绍老年人跌倒警觉度的评估工具及影响因素,从健康教育、认知行为疗法、智能化干预3个方面综述提高老年人跌倒警觉度的干预措施,以期为相关研究及实践干预提供参考。     

A brief fall prevention intervention for manual wheelchair users with spinal cord injuries: A pilot study

Objective: To conduct a pilot study of an intervention to decrease fall incidence and concerns about falling among individuals living with Spinal Cord Injury who use manual wheelchairs full-time.

Design: Pre/post. After a baseline assessment, a structured intervention was implemented. The assessment protocol was repeated 12 weeks after the baseline assessment.

Setting: Research laboratory and community.

Participants: 18 individuals living with SCI who use a manual wheelchair full-time with an average age of 35.78?±?13.89 years, lived with SCI for 17.06?±?14.6 years; 61.1% were female.

Intervention: A 1:1, 45 minute, in-person intervention focused on factors associated with falls and concerns about falling: transfers skills and seated postural control.

Outcome measures: Participants reported fall incidence and completed the Spinal Cord Injury Fall Concerns Scale, Community Participation Indicators and the World Health Organization Quality of Life – short version (WHOQOL-BREF). Transfer quality was assessed with the Transfer Assessment Instrument (TAI) and seated postural control with the Function In Seating Test (FIST).

Results: Recruitment, assessment and delivery of the intervention were successfully completed. After exposure to the intervention, fall incidence significantly decreased, (P?=?0.047, d_{z ?}=?0.507) and FIST scores improved (P?=?0.035, d_z? =?0.54). Significant improvements were also found in the WHOQOL-BREF Physical (P?=?0.05, d_{z ?}=?1.566) and Psychological (P?=?0.040, d_{z ?}=?0.760) domains.

Conclusion: The feasibility of the structured intervention was established and the intervention has the potential to reduce fall incidence and improve quality of life among individuals living with SCI who use a wheelchair. Appropriately powered randomized controlled trials of the program are warranted.     

社区老年人跌倒预防自我管理体验的Meta整合

目的 了解社区老年人跌倒预防自我管理的真实体验,为开展针对性跌倒自我管理干预提供依据。方法 文献检索中英文数据库中有关老年人跌倒自我管理体验和经历的质性研究,检索时限从建库至2023年8月1日。采用澳大利亚JBI循证卫生保健中心对质性研究质量评价标准评价文献,依据主题分析法对符合评价标准的质性研究进行Meta整合。结果 共纳入8篇文献,提炼34个结果,归纳形成11个类别,整合成4个研究结果,即复杂的情绪和行为、跌倒预防自我管理行为促进因素、跌倒预防自我管理面临的阻碍、心理支持和专业医疗支持需求。结论 社区老年人在跌倒预防自我管理过程中面临复杂的情绪行为以及困难和挑战,医护人员需关注其应对方式、内心体验和需求,完善医疗和社会支持系统,促进社区老年人跌倒预防自我管理行为。     

虚拟仿真联合志愿服务用于本科护生老年人跌倒护理教学研究

目的 探讨虚拟仿真联合志愿服务用于本科护生老年人跌倒护理教学中的效果。方法 以309名三年级本科护生为研究对象,在老年护理学课程的老年人跌倒教学单元开展基于虚拟仿真实验和志愿服务教学,即课前线上学习和虚拟仿真实训、课中课堂翻转、课后志愿服务;课后评价教学效果。结果 护生使用老年人跌倒护理虚拟仿真实验次数4（3,4）次,考核成绩显著高于上一届护生（P＜0.05）,教学目标达成度为62.8%～93.9%,对教学促进作用的认同度为74.1%～94.8%。结论 虚拟仿真联合志愿服务教学可有效提高本科护生老年人跌倒护理教学效果。     

Lower urinary tract symptoms increase the risk of falls in older men

OBJECTIVE

To evaluate the association of lower urinary tract symptoms (LUTS) with the risk of falls in elderly community‐dwelling men.

SUBJECTS AND METHODS

We evaluated 5872 participants in the Osteoporotic Fractures in Men, a prospective cohort study of risk factors for falls and osteoporotic fractures among community‐dwelling men aged ≥65 years. The primary outcome was the 1‐year cumulative incidence of falls in men with moderate or severe, vs mild LUTS at baseline, as measured by the American Urological Association Symptom Index. We used Poisson regression models and considered multiple variables as potential confounders.

RESULTS

At baseline, 3188 (54%) reported mild, 2301 (39%) moderate, and 383 (7%) severe LUTS. Compared with men who had mild symptoms, the adjusted 1‐year cumulative incidence of falls was significantly higher among men with moderate or severe LUTS. The risk of at least one fall was increased by 11% among those with moderate (relative risk 1.11, 95% confidence interval, CI, 1.01–1.22; P = 0.02) and by 33% among those with severe LUTS (1.33, 1.15–1.53; P < 0.001). Further, those with moderate LUTS had a 21% (1.21, 1.05–1.40; P = 0.01) and those with severe LUTS a 63% (1.63, 1.31–2.02; P < 0.001) greater risk of at least two falls. LUTS most strongly associated with falls were urinary urgency, difficulty initiating urination, and nocturia.

CONCLUSIONS

Moderate and severe LUTS independently increase the 1‐year risk of falls, particularly recurrent falls, in community‐dwelling older men. Because of the serious consequences of falls, these results might justify the routine assessment of LUTS with a validated questionnaire in the primary care of this population.     

Capitellar osteochondritis dissecans in an elite pre-adolescent gymnast: a case report and overview

ObjectiveFollowing sports injury, a timely and accurate diagnosis is important, so as to initiate appropriate care as soon as possible. This is perhaps even more paramount in pediatric athletic trauma, particularly during the pre-puberty through adolescent years of rapid skeletal growth. This paper presents the diagnosis and management of osteochondritis dissecans in its third most common location, the elbow, a presentation of which chiropractors should be aware, including the importance of timely diagnosis and appropriate treatment.Clinical featuresA 9-year-old elite gymnast presented at a chiropractic clinic with elbow pain and restricted range of motion after a fall during training. Following multidisciplinary involvement, the diagnosis was eventually made as osteochondritis dissecans.Intervention and outcomesThe patient underwent successful arthroscopic surgery in order to remove the osteochondral fragment, followed by a specific regimen of rehabilitation exercises, which helped to enhance and accelerate optimal healing for her return to athletic activity.SummaryThis case reminds the practicing chiropractor of the valuable role he/she can play in a multidisciplinary management of pediatric sports trauma, particularly in diagnosis and post-surgical care. A literature review presents a synopsis of the reported clinical presentations, diagnostic assessment and therapeutic options for capitellar osteochondritis dissecans.     

Predictors of falls among postmenopausal women: results from the National Osteoporosis Risk Assessment (NORA)

Summary  Using data from 66,134 postmenopausal women enrolled in the National Osteoporosis Risk Assessment (NORA) study, more than half of whom were less than age 65, we identified 18 risk factors that independently predicted a significantly increased risk of falling and observed a graded increase in risk with an increasing number of risk factors. Introduction  This study was designed to identify predictors of falls in a large prospective study of community-dwelling, postmenopausal women, 58% of whom were less than 65 years old at baseline. Methods  We exclusively used survey data from 66,134 NORA participants who completed the baseline survey and three follow-up surveys over 6 years. Stepwise logistic regression was used to select potential fall predictors. A simple fall risk index was created by giving one point to each significant independent risk factor. Results  More than one third (38.2%) of participants reported at least one fall since baseline. The largest predictor of fall risk was history of falls (odds ratio [OR] = 2.7). In the multivariate analysis, 17 additional risk factors were significantly associated with incident falls (but with smaller OR), including age, college education, poor hearing, diabetes, personal or family history of fracture, hypothyroidism, and height loss. Of the 3,346 women with zero fall risk factors, 22.6% reported falling compared to 84.3% of the 51 women with ≥11 risk factors. Conclusions  This large cohort had sufficient power to identify 18 risk factors that independently predicted a significantly increased risk of falling with a graded increase in risk with increasing number of risk factors. These results have been previously presented at the 7th International Symposium on Osteoporosis, National Osteoporosis Foundation, Washington, DC, April 2007.     

Hip fractures after falls in hospital: A retrospective observational cohort study

Objectives

To compare the prevalence and characteristics of hip fractures sustained after inpatient falls (hospital subgroup) to those presenting with a fall in the community (control group).

Design

Retrospective observational cohort study.

Setting

University teaching hospital.

Participants

5879 hip fractures occurred over an 8-year period, 327 of these took place after a fall as a hospital inpatient.

Outcome measures

Comparison of 30-day and 1 year mortality, co-morbidities, length of post-fracture hospital stay, specific complication rates and cognitive function between the hospital and control group. Other specific data on those falling in hospital was also collected.

Results

There were significantly higher rates (p < 0.001) of cerebrovascular, chronic obstructive airways and renal disease, diabetes, malignancy and polypharmacy in patients suffering falls in hospital. Mini-mental test scores (MTS) were also significantly reduced in this subgroup (p < 0.001). 30-day and 1 year mortality rates were 9% and 26%, respectively in the control group and almost double this in the hospital subgroup, being 18% and 47%, respectively (30 days, 95% CI 2.00 (1.54-2.60): p < 0.001; 1 year, 95% CI 2.04 (1.73-2.40): p < 0.001). There was no statistical difference between post-operative complications or length of stay post-fracture. 55% of falls in hospital took place on medical/geriatric wards with an additional 14% occurring on psychiatric units.

Discussion

Patients suffering hip fractures after falls in hospital are frailer with impaired cognitive function and have more co-morbidities than those suffering a fracture in the community. These patients have increased mortality, with almost 50% dead within 1 year of the fall. The majority of hip fractures after falls occur in medical or geriatric wards, but the highest risk group appears to be elderly patients on psychiatric wards. Therefore, falls risk assessment and falls prevention schemes in hospital elderly patients are of paramount importance.     

Spinal Cord Injury and Aging: Exploring the Unknown

ABSTRACT

We conducted a retrospective case-control study of falls over a four year period on a 30 bed neurorehabilitation unit at the Burke Rehabilitation Hospital to characterize the nature of falls and identify factors associated with falling. The most common diagnoses treated on the unit were traumatic spinal cord injury, brain injury, and multiple sclerosis; stroke patients are treated on another service. Falls represented 72 percent of all incident reports made to the Nursing Office during the study period. One hundred seventeen (117) falls occurred in 82 patients during a time when the unit census was 28,622 patient days, yielding a rate of 1,439 falls per 1,000 patient years. One hundred fourteen (114) patients admitted with no history of falling during the same period were selected randomly for comparison. Most falls were associated with no injury (n=96) or minor injury (n=18). The most significant injuries occurred in three cases with lacerations requiring sutures. Falls occurred with greatest frequency during the first and fourth quartiles of the hospital stay, during the evening and while bed transfers were being performed. No association between falling and patient age, sex, diagnosis, number of medications, use of sedating medications, presence of motor, visual or cognitive impairment or orthostatic hypotension was evident. An increased risk of falling was associated with physician orders for Posey restraints. The implication of these findings for falls prevention programs is discussed. (J Am Paraplegia Soc: 17; 179–182)