老年人恐惧跌倒相关性活动限制的研究进展

恐惧跌倒相关性活动限制在老年人中普遍存在,限制活动会给老年人带来严重危害。现存研究大多聚焦于跌倒和跌倒恐惧,对恐惧跌倒相关性活动限制的关注度不够。该文从老年人恐惧跌倒相关性活动限制的概述、测量工具、危害、影响因素、干预方法和效果5个方面进行综述,旨在提高医护人员对老年人恐惧跌倒相关性活动限制的关注,为进一步开展相关研究提供参考。     

Fear of Falling: A Qualitative Study Among Community-Dwelling Older Adults

The aim of this qualitative study was to uncover why older adults experience the fear of falling and discover the perceived consequences older adults fear. Seven participants between 61 and 88 (M = 75.4, SD = 9.1) years were interviewed. It was identified that participants developed the fear of falling after they had fallen or as they aged. Six themes related to the fear of falling were revealed, including Physical Injury, the Feeling Experienced when Falling, Becoming an Invalid or Burden, Losing Independence and Being Institutionalized, A Long Lie, and Being Confined to a Wheelchair or Unable to Walk. The results from this study indicated that older adults fear the consequences of falling. However, they fear not only physical injury as a result of the fall, but the injury's consequences that may precipitate the individual becoming more dependent on others and experiencing life altering events.     

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。     

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.     

苏州市老年公寓老年人跌倒危险因素的研究

目的了解苏州市老年公寓老年人跌倒现状及影响因素,为老年公寓工作人员预防老年人跌倒管理提供实证依据。方法采用一般资料问卷和社区老年人跌倒危险评估问卷对677名老年公寓内老年人跌倒情况进行调查。结果 677名老年人中有180名跌倒,跌倒发生率为26.59%,性别、影响自身平衡能力的患病种数、视力异常、躯体感觉异常、对活动能力的自我评估、在自己家内安全行走、居家环境危险因素是老年公寓老年人跌倒高危因素。结论老年公寓老年人跌倒率较高,突出表现为性别和影响自身平衡患病种数有关。需控制跌倒风险,优化老年公寓环境,加强平衡和运动控制训练等,降低老年公寓老年人跌倒发生率。     

The relationship between fear of falling,activities of daily living and quality of life among elderly individuals

Abstract The purpose of the present study was to examine the relationship between functional disability and fear of falling during daily activities. Also examined was the relationship between fear of falling and health-related Quality of Life (QOL). Health-related QOL concepts were measured using the Short Form 36 Health Survey (SF-36) within an elderly day services sample. Eligible subjects were elderly persons using Day Service (type B) who were capable of independently answering a questionnaire and had no memory problems. Forty-three males and 92 females were eligible for this study. Forty-nine (36.3%) subjects expressed no fear of falling, whereas 22 (16.3%) reported that they were very fearful of falling. Among females, walking and bathing had a highly significant relationship with the fear of falling. The fear of falling can contribute to psychological conditions such as depression, and also impacts on the health-related QOL of frail elderly people. Thus, it is critical to provide integrated health care activities for these individuals that address both psychological well-being and physical functioning.     

A structural equation modelling approach to the complex path from postural stability to morale in elderly people with fear of falling

Purpose.?To test a model of the path from Activity Limitation (postural instability) to participation (morale), taking account of the influence of psychological variables of appraisal, emotion and self-efficacy. Also to attempt to define whether elderly people with fear of falling are fearful because they are posturally unstable or because they are generally anxious.

Method.?Elderly inpatients (n?=?153, age: 67–95, 31% men) were assessed shortly before their discharge home. They were invited to complete tests of postural stability and questionnaires about consequences of falling, previous experience of falls, subjective unsteadiness, emotional state, balance confidence, concern and fear about falling and morale. Results were treated with Pearson correlations and structural equation modelling.

Results.?All variables related to morale, the highest correlation being with anxiety and depression. However, there was no direct path from postural instability to morale. Balance confidence and fear of falling formed separate end points, neither affecting morale.

Conclusions.?Morale alone is not an adequate outcome of rehabilitation. Increased balance confidence and reduced fear of falling need to be addressed in their own right and assessed independently of morale in elderly rehabilitation.     

Analysis of measurement tools of fear of falling for high-risk, community-dwelling older adults

Fear of falling has many health consequences among older adults and may lead to curtailment of activities, immobility, functional dependence, falls, and serious injury. The lack of clarity as to how to best measure fear of falling among high-risk, community-dwelling older adults defined as those who are nursing home eligible, functionally dependent, and vulnerable is further complicated by the multiple definitions used throughout the science. Fear of falling is important to measure effectively if we are to develop and test interventions to promote safe aging in place and prevent injury and institutionalization. This integrative review, 1982 to the present, leads to the conclusion that the Falls Efficacy Scale-International (FES-I) long form stands out as the most appropriate measurement tool to best assess fear of falling in this unique, understudied, and underserved population.     

跌倒危险度分级及防跌倒流程在老年患者中的应用

目的探讨跌倒危险度分级及防跌倒流程在老年患者中的应用效果。方法选择2008年5月-2009年5月本科室收治的住院老年患者750例为对照组,选择2009年6月-2010年6月768例老年患者为实验组。对照组采用常规的防跌倒护理,实验组应用跌倒危险度分级及防跌倒的流程对患者实施防跌倒护理,比较两组患者的跌倒发生率。结果两组患者跌倒发生率比较,P<0.01,差异具有统计学意义,实验组患者跌倒发生率低于对照组。结论跌倒危险度分级及防跌倒流程的使用能有效降低住院老年患者跌倒的发生率,保障老年住院患者的护理安全。     

Effects of a Task-specific Exercise Program on Balance,Mobility, and Muscle Strength in the Elderly

[Purpose] The aim of this study was to investigate the effects of a task-specific exercise program based on motor learning on balance ability and strength of the lower extremity in the elderly with/without falling experiences. [Subjects and Methods] Individuals who had experiences of falling over 2 times within the past 6 months were included in the falling group. The task-specific exercise program consisted of 3 stages (weeks 1–2, 3–4, and 5–6) and was conducted according to the level of difficulty in this study. [Results] The scores of the Korean version of the Activities-Specific Balance Confidence Scale and Performance-Oriented Mobility Assessment were significantly changed in both the falling group and non-falling group after the task-specific exercise program. In comparisons between the falling group and non-falling group, there were also significant differences in the Korean version of the Activities-Specific Balance Confidence Scale and muscle strength of the semitendinosus and gastrocnemius. [Conclusion] The task-specific exercise program has a positive effect on balance ability and muscle strength related to falls in the elderly.Key words: Falling, Task-specific exercise, Elderly people     

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.     

A multidisciplinary fall prevention program for elderly persons: a feasibility study

Falling is a common problem among elderly people and has many negative consequences. In the Netherlands, there is a need for effective fall prevention interventions aimed at elderly persons with an increased risk of falling. For this reason, we adapted a successful British fall prevention program comprising a medical occupational therapy assessment to the Dutch health care setting. This article describes the adaptation of this program and a pilot study to assess its feasibility in Dutch health care according to the implementers of the intervention as well as the participants (n = 21). This study showed that the Dutch intervention protocol is feasible in Dutch health care for both participants and implementers of the program. However, minor refinement of the intervention is warranted to improve its feasibility. The structured approach to adapt and pretest an intervention protocol appeared to be essential when aiming to implement a complex intervention program in a different health care setting.     

Recurrent Elderly Fallers

Factors associated with recurrent failing during a one-year period were analysed among elderly Finns (65 yrs and more) seeking medical treatment due to a fall. Recurrent falling in men was independently related to a lesser amount of depressive symptoms and to less severe injury due to the first fall.

In women, recurrent falling was independently related to the non-occurrence of a fear of falling. Furthermore, recurrent falling, amount of daily movement, mental capacity, and falling during the previous year were related variables. Here the risk of recurrent falling was high among persons with poor mental capacity, who moved about a large amount daily, and who had had at least one accident during the previous year. In addition, there was an association between poor health and recurrent falling in women.

Demented women moving about daily, frail women, and incautious men and women seemed to be the main risk groups for repeated falling. What could general practitioners do to prevent repeated falls in the elderly? First, the overall health status and functional capacities of frail elderly women should be improved. Second, all elderly persons, especially those who have fallen, should be informed about how to minimize the risks of falls. Prevention is not easy among the demented population, however.     

Effects of passive body heating on body temperature and sleep regulation in the elderly: a systematic review

Insomnia in the elderly is associated with circadian body temperature changes. Manipulating body temperature prior to sleep onset may improve sleep quality in the elderly. This systematic review analyzed the effect of passive body heating on body temperature and sleep quality. Three studies related to passive body heating for the elderly identified from a computerized database search were evaluated. All of them used crossover designs to examine effects of passive body heating on sleep quality. Passive body heating such as a warm bath immersed to mid-thorax with 40–41°C water for 30 min in the evening could increase rectal body temperature, delay occurrence of body temperature nadir and increase slow wave sleep (deep sleep) in healthy female elderly with insomnia. The elderly also perceived “good sleep” or “quickness of falling asleep” after the bathing condition. Evening warm bath facilitates nighttime sleep for the healthy elderly with insomnia.     

Dementia and falls]

INTRODUCTION: Dementia is now a frequent disease in elderly and may be a major risk of falling. Usually these falls are multiple and serious, but their consequences are not specific. All types of dementia (Alzheimer's disease, dementia with Lewy bodies, dementia in Parkinson's disease, fronto-temporal dementia, vascular dementiaellipsis) and all stages of evolution are concerned.Discussion: These falls result from cognitive and behavioural disorders, visual and motor problems, gait and balance disturbances, malnutrition, adverse effects of medication and fear of falling. CONCLUSION: Prevention is possible. Attention must be given on the patient himself (keeping in good health, limitation in sedative treatment and mechanical restraintsellipsis) and on his environment (lighting, obstacles on the ground, stress levelellipsis). After a fall, especially after a complicated fall, rehabilitation modalities and aims must be adapted but caring must not be defeatist. Randomized studies need to be realized.     

Falling among the sensorially impaired elderly

Recent studies of the healthy elderly indicate that accidental falls account for many lengthy hospital stays and permanent disabilities. An ongoing investigation by our group is examining the contribution of neuromuscular feedback and the possible substitution of visual-perceptual feedback as a major contributor to falling in this population. This combination of decreased weighting of neuromuscular factors and increased weighting of the visual-perceptual factors led to the following hypothesis: Those persons who cannot see should show less change in frequency of falling as they age than sighted cohorts. The deaf, who rely more than others on visual perceptual stimuli, are less likely to fall as they age than the general elderly population, who first begin to rely more heavily on visual stimuli when they age. Thus, the deaf and blind constitute a population whose change in frequency of falls with increased age should differ markedly from change in the frequency of falls among the nonblind and nondeaf segments of the population. Our results support the hypothesis. The blind demonstrated a higher rate of falls than the deaf or nonimpaired population. However, the more elderly blind failed to show the increase in falling demonstrated by the deaf and nonimpaired. If these findings are confirmed in subsequent studies, the nonimpaired and deaf elderly could be trained to focus on visual feedback. The blind may be able to reduce the frequency of falls by enhancing musculoskeletal feedback and strength via exercise.     

应用标准护理程序预防住院老年患者跌倒的效果

目的：探讨应用标准护理程序预防住院老年患者跌倒的效果。方法：将实施标准护理程序后即2011年1～12月的4377例65岁以上的老年患者作为观察组,观察跌倒发生情况,并与2010年1～12月未实施标准护理程序的65岁以上的4025例患者作为对照组进行比较。结果：观察组跌倒发生率明显低于对照组（P〈0.05）。结论：应用标准护理程序可有效减少住院老年患者的跌倒发生率。     

老年住院患者发生跌倒相关因素的病例对照研究

目的：分析老年住院患者发生跌倒的相关因素,为预防老年住院患者发生跌倒提供参考依据。方法选取广州市某三级甲等医院发生跌倒老年住院患者120例为观察组,按疾病诊断、年龄、性别进行1∶1配对,选取同期住院未发生跌倒老年患者120例为对照组。对影响老年住院患者发生跌倒的相关因素进行多因素Logistic 回归分析。结果有跌倒史、肢体乏力/疼痛、视力障碍、起立测试异常是老年住院患者发生跌倒的危险因素（P＜0.05）。结论需加强对有跌倒史、视力异常及躯体活动平衡能力较差的老年住院患者护理,做好跌倒风险评估及预防措施。