社区老年人跌倒警觉度现状及影响因素分析

目的 了解社区老年人跌倒警觉度现状,分析影响因素,为制定跌倒预防管理策略提供参考。方法 采用便利抽样法抽取合肥市3个社区628名老年人为研究对象,采用一般资料调查表、跌倒警觉度量表、跌倒风险自评量表、匹兹堡睡眠质量指数量表及简易衰弱量表进行调查。结果 社区老年人跌倒警觉度得分为（52.94±8.83）分。多元线性回归结果显示,受教育程度、近1年跌倒史、久坐爱好、害怕跌倒、跌倒风险、睡眠障碍、衰弱状态是社区老年人跌倒警觉度的影响因素（均P＜0.05）。结论 社区老年人跌倒警觉度处于较低水平,应针对影响因素制定个性化干预措施,以增强老年人跌倒警惕意识,降低跌倒发生率。     

老年住院患者跌倒风险评估量表的构建及验证

目的构建老年住院患者跌倒风险评估量表并进行测评验证,考察其应用价值。方法采用专家问卷咨询、专家座谈会及病例(246例65岁以上老年住院患者)对照研究相结合的方式构建老年住院患者跌倒评估量表,运用SPSS20.0软件对量表进行信、效度检验,并与Morse跌倒评估量表比较预测准确性。结果老年住院患者跌倒风险评估量表共纳入14个大条目35个赋值子条目;内容效度(CVI)为0.916;量表总体Cronbach′sα系数为0.757;测量者间客观信度0.894;量表的ROC曲线下面积为0.980,Morse跌倒评估量表为0.927;老年住院患者跌倒风险评估量表总分21分、41分及60分时特异度分别为0.38、0.71及0.96;Morse跌倒评估量表总分25分、45分及80分时特异度分别为0.27、0.50及0.82。结论本次构建的老年住院患者跌倒风险评估量表有较好的信效度,对老年住院患者跌倒风险预测准确性好,可应用于临床。     

老年住院患者复合跌倒风险评分表的构建及应用研究

目的 构建老年住院患者复合跌倒风险评分表,提高老年住院患者跌倒风险评估准确性。方法 整合约翰霍普金斯跌倒评定量表和HendrichⅡ跌倒风险模型作为初始条目;采用前瞻性研究,收集42 490例老年住院患者跌倒发生情况及相关风险因素,通过χ2检验和logistic回归分析确定跌倒的影响因素,构建老年住院患者复合跌倒风险评分表。将复合跌倒风险评分表在1 663例老年住院患者中进行验证。结果 logistic回归分析得到18项危险因素,将各危险因素的风险比值比（OR）进行赋值,总分为100分。验证结果显示,老年住院患者复合跌倒风险评分表的ROC曲线下面积为0.825（95%CI：0.798~0.852）,最佳截断值为7.5分,灵敏度为0.736,特异度为0.771。结论 老年住院患者复合跌倒风险评分表能有效预测老年住院患者的跌倒风险,有助于临床护理人员及时筛查出高危患者,从而进行有针对性的预防干预。     

老年2型糖尿病患者害怕跌倒现状及影响因素分析

目的了解老年2型糖尿病患者害怕跌倒情况及相关影响因素,为开展针对性护理干预以预防跌倒发生提供参考。方法选取老年2型糖尿病患者128例,采用一般资料调查表、害怕跌倒评估、简易精神状态检查量表、简易虚弱问卷、老年焦虑量表、简版老年抑郁量表进行调查。结果 63例(49.22%)老年2型糖尿病患者存在害怕跌倒心理;患者害怕跌倒心理与焦虑、抑郁水平呈正相关(均P0.01);多因素Logistic回归分析结果显示,年龄、过去1年内有跌倒史、抑郁是害怕跌倒的独立危险因素(均P0.01)。结论老年2型糖尿病患者害怕跌倒心理存在的比例较高,患者年龄、抑郁水平及过去1年内跌倒史与害怕跌倒密切相关。加强防跌倒健康教育及改善情绪状态有助于缓解其害怕跌倒心理,降低患者再次跌倒的风险。     

老年冠心病住院患者Ⅱ期心脏康复参与意愿及影响因素分析

目的 调查老年冠心病住院患者Ⅱ期心脏康复参与意愿，并探讨其影响因素，为临床开展心脏康复干预提供参考。方法 采用一般资料调查表、Ⅱ期心脏康复知识问卷、心脏康复参与意愿量表对180例老年冠心病住院患者进行调查。结果 老年冠心病住院患者的Ⅱ期心脏康复知识得分为(75.54±19.43)分，Ⅱ期心脏康复参与意愿均分为(2.46±0.74)分。多因素分析结果显示，Ⅱ期心脏康复知识、有跌倒史、曾参与Ⅰ期心脏康复是患者Ⅱ期心脏康复参与意愿的影响因素(调整R²=0.250,均P<0.05)。结论 老年冠心病住院患者Ⅱ期心脏康复参与意愿处于中等水平。应根据其影响因素，加强健康教育及积极干预，提升其心脏康复参与意愿，促进康复。     

两表一书联用预防内科老年住院患者跌倒

目的 减少老年患者住院期间意外跌倒的发生.方法 自行设计跌倒危险因素评分表、预防跌倒告知书、预防跌倒宣教表(两表一书)于2007年8月至2008年9月用于441例经评估有潜在跌倒风险的内科老年住院患者:对有跌倒潜在风险的患者进行评分→告知家属或患者→签名→健康教育→签名,并根据患者的实际情况,住院时、住院期间循环不断地重复以上流程,患者出院时将两表一书保存在病历中留档.结果 441例无1例发生跌倒意外.结论 对患者进行动态防跌倒危险评估利于对跌倒危险患者重点防范,加强预防跌倒知识教育可降低患者跌倒发生,确保患者住院期间的安全,减少医疗纠纷.     

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。     

两种健康教育方式防止老年住院患者跌倒的效果观察

目的探讨老年住院患者防跌倒健康教育的效果。方法将356例65岁以上的老年住院患者随机分为两组各178例,对照组采用说教式的集体教育,观察组采用以人为本、因人施教的健康教育。结果观察组对防跌倒相关知识了解程度明显高于对照组(均P<0.01),随访期间观察组跌倒发生率明显低于对照组(P<0.01)。结论对老年住院患者实施以人为本、因人施教的防跌倒健康教育,能提高老年患者对跌倒危险因素的认知,采取预防跌倒措施,降低跌倒发生率。     

有跌倒史的住院患者再次跌倒的影响因素分析

目的分析有跌倒史的住院患者发生再次跌倒的危险因素,为跌倒预防提供参考。方法回顾性收集209例跌倒患者病例资料,对其中112例再次跌倒患者的相关因素进行分析。结果不同年龄、损伤程度、头晕、步态平衡、肢体乏力/疼痛、视力、特殊用药种类,以及是否合并高血压、糖尿病、神经系统疾病、骨质疏松的患者再次跌倒发生率比较,差异有统计学意义(P0.05,P0.01)。Logistic回归分析显示,年龄大、步态不稳、合并神经系统疾病是患者再次跌倒的危险因素(P0.05,P0.01)。结论有跌倒史的住院患者发生再次跌倒受多种因素的影响。在评估患者跌倒风险时,应重视患者的跌倒病史,尤其对年龄大、步态不稳及合并神经系统疾病的患者应加强防跌倒宣教,做好前瞻性的预防措施,避免患者再次跌倒。     

老年住院患者陪护预防跌倒知信行调查

目的调查老年住院患者陪护对预防跌倒的认知情况,以便有针对性地对陪护者实施护理对策,预防住院老年患者跌倒的发生。方法采用自行设计的老年住院患者陪护预防跌倒问卷,对100名老年住院患者的陪护者进行调查。结果陪护者对患者跌倒相关风险的认识为36.00%~65.00%;不同年龄、不同陪护角色、不同陪护时间的陪护者知识、态度和行为得分不同(P0.05,P0.01)。结论陪护人员对老年住院患者的预防跌倒认知上存在差异,护理人员应重视并加强老年住院患者陪护人员预防跌倒相关知识持续专业性的个体化教育,以减少老年患者跌倒的发生。     

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)     

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.     

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.     

Danger at every rung: Epidemiology and outcomes of ICU-admitted ladder-related trauma

IntroductionThe incidence of ladder-related falls is increasing, and this represents a disturbing trend, particularly in the context of increased life expectancy and the impending retirement of the populous ‘baby-boomer’ generation. To date, there have been no critical illness-focused studies reporting on the incidence, severity and outcomes of severe ladder-related injuries requiring ICU management.MethodsMajor trauma patients admitted to ICU over a 5 year period to June 2011 after ladder falls >1 m were identified from prospectively collected trauma data at a Level 1 trauma service. Demographic and ICU clinical management data were collected and non-parametric statistical analyses were used to explore the relationships between variables in hospital mortality/survival.ResultsThere were 584 ladder fall admissions, including 194 major trauma cases, of whom 29.9% (n = 58) fell >1 m and were admitted to ICU. Hospital mortality was 26%, and fatal cases were almost entirely older males in domestic falls of ≤3 m who died as a result of traumatic brain injury. Non-survivors had lower GCS at the scene (p = 0.02), higher AIS head code (p = 0.01), higher heart rate and lower mean arterial pressure (p < 0.01) in the initial 24 h period in ICU, and were ≥55 years of age (p = 0.05). Only 46% of patients available for follow-up were living at home at 12 months without requiring additional care.ConclusionsThe incidence of ladder falls requiring ICU management is increasing, and severe traumatic brain injury was responsible for the majority of deaths and for poor outcomes in survivors. In-hospital costs attributable to the care of these patients are high, and fewer than half were living independently at home at 12 months post-fall. A concerted public health campaign is required to alert the community to the potential consequences of this mechanism of injury. The use of helmets for ladder users in domestic settings, where occupational health and safety regulations are less likely to be applied, is strongly recommended to mitigate the risk of severe brain injury. The benefits of this simple strategy far outweigh any mild inconvenience for the wearer, and may prevent catastrophic injury.     

Frequency of fall-related injuries of female patients referred to the trauma center in the city of Kashan from years 2005 to 2008

Objective:Falls are one of the life events leading to injury and in serious cases cause high morbidity and mortality.This research was conducted to determine the fall incidence among female population ...     

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.     

Stair falls: caregiver’s “missed step” as a source of childhood fractures

Background

The purpose of this study was to describe fractures sustained by children and to analyze the associated costs when a caretaker falls down stairs while holding a child.

Materials and methods

Between 2004 and 2012, 16 children who sustained a fracture after a fall down stairs while being carried by a caregiver were identified. Parents/caregivers were interviewed to see how the fall occurred, and a cost analysis was performed.

Results

The average age of the patients was 14.5 months (7–51 months). The lower extremity was involved in 15 of 16 fractures, with 8 involving the femur. The majority were buckle fractures, but all diaphyseal femur fractures were spiral. Three patients required a reduction in the operating room. All fractures healed with cast immobilization. Five patients underwent skeletal surveys, as the treating physicians were concerned about potential child abuse. The average cost of treatment was $6785 (range $948–45,876). Detailed histories from the caregivers showed that they “missed a step” due to the child being carried in front of the caregiver, obscuring their vision.

Conclusions

A fall in a caregiver’s arms while going down stairs can result in multiple orthopedic injuries. The costs of treating these injuries are not insignificant, and the suspicion of child abuse can be both costly and unnecessary in the case of a true accident. While descending the stairs with a child in their arms, the caregiver should hold the child to the side so as not to obscure their vision of the step with one arm, ideally holding the handrail with the other.

Level of evidence

IV case series.