社区老年人跌倒的原因分析及护理干预进展

跌倒是老年人常见的健康问题之一，也是老年人独立生活的共同障碍。本文通过文献回顾，阐述了老年人跌倒的流行病学，分析了老年人跌倒的危险因素，探讨了老年人跌倒的危险因素评估方法。为了提高老年人的生活质量，降低医疗保健费用的支出，减轻社会、家庭、疾病的负担，必须加强对老年人跌倒预防的护理干预。     

老年住院患者跌倒的护理进展

随着人口老龄化进程加快和期望寿命延长,老年人的健康和生活质量日益受到关注。老年人跌倒是一个重要的公共卫生问题[1]。跌倒对老年人的危害性很大,跌倒轻则皮肤组织擦伤、淤血、水肿或撕裂伤,重则骨折、颅内出血甚至死亡 [2]。跌倒还导致老年人日常生活活动能力(ADL)和行走能力的下降,并可导致严重的功能残疾和生活质量的下降。跌倒或险些跌倒还可能使老年人产生担心跌倒的心理而对自己限制活动,使老年人生活依赖性增加和活动能力下降,这样又增加了跌倒的危险性,形成恶性循环。为保持老年人较高生活质量,降低医疗费用支出,减轻社会疾病负担,老年人跌倒的预防控制已成为公共卫生问题和健康问题[3] 。研究老年人跌倒的危险因素、跌倒高危人群评估及预防跌倒的干预措施成为卫生保健专业工作者努力的方向之一,本文对有关老年人跌倒的预防护理现状综述如下。     

老年人跌倒原因分析及预防对策

跌倒是老年人最常见、最易发生的意外事件，加上自身生理功能衰退，跌倒后致伤、致残，生存质量急剧下降，给本人、家庭及社会均带来不良影响。因此预防老年人跌倒已成为医务人员探索的课题之一。本文收集了40例老年人发生的意外跌倒事件，探讨发生跌倒的相关因素和预防措施，从而使他们延年益寿。提高生活质量。[第一段]     

非连续性教育方法在提高社区老年人生存质量和预防跌倒中的应用

目的:探讨非连续性教育方法在提高社区老年人生存质量和预防跌倒中的应用效果。方法:对36例65岁以上的老年人进行充分评估后采取非连续性教育,干预1年后比较老年人生活质量和预防跌倒知识的掌握情况。结果:干预后生存质量评分和预防跌倒知识知晓率均有所提高,尤其在生理、心理、社会能力方面有较明显的统计学意义(P0.01),老年人参与预防跌倒健康教育讲座的积极性及跌倒知识掌握情况也明显高于干预前(P0.05)。结论:采用非连续性教育思想实施健康干预,能明显提高老年人参与预防跌倒相关知识技能的学习积极性,能有效地提高老年人的生存质量和预防跌倒知识知晓率。     

防跌伤工具表在老年患者中的应用

跌倒是指平地行走或从稍高处摔倒在地[1].有数据表明,65岁以上老年人每年约1/3的人跌倒1次或多次,并随着年龄增长而增加,跌倒常造成严重损伤,降低老年人活动能力并可导致严重心理障碍或社会后果,严重影响老年人的健康和生活质量.     

住院老年患者跌倒原因与防范的研究进展

跌倒是老年人常发生的意外事件,对老年人生理、心理和社会经济带来不良影响。本文通过对住院老年患者跌倒危险因素的分析,提出老年患者跌倒是生理和心理状况、疾病、药物、环境因素与家庭社会支持以及护理人员等诸多因素交互作用的结果,并建议采取包括跌倒风险评估、安全教育、功能锻炼、心理护理、环境支持、提高家属、陪护和护理人员预防跌倒意识等多元化的综合防范措施使跌倒的发生率降至最低,确保每位住院老年患者的安全,以提高老年人的生活质量。     

老年人防跌意识的树立与社区健康教育相关性的研究

目的 了解老年人跌倒自我认知状况及社区健康教育在预防老年人跌倒中的作用。方法 对435位老年人进行跌倒自我认知调查及防跌健康教育自身对比研究。结果 健康教育前后老年人跌倒自我认知意识有显著差异。防跌知识最希望由医生、护士讲解获得。结论 健康教育能提高老年人防跌意识,有利于老年人生活质量提高;医生、护士参与健康教育成效显著;社会传媒应加强有关老年人健康教育宣传;老年人对医生、护士在健康教育中的权威作用信赖,社区工作者应积极参予老年人健康教育工作。     

老年人跌倒自我效能的研究进展

正跌倒是指突发的,不自主的,非故意的体位改变而导致倒在地面或比初始位置更低的平面上的状态~[1]。跌倒可导致老年人伤残,失能,严重影响老年人的生活质量甚至引起死亡,给家庭和社会带来巨大的负担~[2]。据统计~[3],65岁以上老年人的跌倒率达到30%,80岁以上的老年人跌倒率高达50%。跌倒不仅造成生理上的伤害,也能引起自理     

社区老年人预防跌倒认知与行为的调查分析

目的调查社区老年人跌倒的状况及其预防认知与行为。方法选择广州市3个社区86名60岁以上老年人,采用自行设计问卷了解老年人的跌倒史及其跌倒预防认知与行为情况。结果社区老年人跌倒发生率为50.00%,60.47%发生在公共场所,发生跌倒主要原因为环境因素。社区老年人对跌倒高危因素的认知得分为(51.38±15.26)分,预防跌倒行为得分为(35.29±8.06)分。结论老年人对跌倒相关因素认识不足,预防跌倒行为不够,应重视对老年人跌倒危险度的评估,加强防跌倒的相关教育,降低老年人跌倒的发生率,提高老年人生活质量。     

封面文章

正随着我国逐渐步人老龄化社会,近年来,老年人相关疾病的研究受到越来越多的关注。脑白质病变是一种常见的中老年脑影像表现,常引起认知功能下降、平衡步态异常、跌倒等,由此引发的跌倒作为老年人常见的伤害性事件,其发生率高,是老年人群伤残、生活依赖和死亡的重要原因,对老年人的健康及生活质量威胁甚大,是威胁老年人健康的一个重要公共卫生问题。跌倒的临床评估手段很多,但仅     

Fall prevention in assisted living: assessment and strategies

Residents in assisted living residences have similar risk factors for falls as do community-residing older adults and, as such, can benefit from the research findings on falls prevention conducted with that population. Some risk factors can be managed, such as, medication side effects, and muscle weakness; others such as degenerative neurological changes, cannot. Knowing a resident's falls history and conducting a full risk assessment, in combination with appropriate interventions, can reduce the probability of a future fall. Exercise appears to be the most effective factor in reducing the risk of falls and injuries from falls. The fear of falling, whether or not associated with a previous fall, is more common among older women and can seriously restrict their quality of life. This article describes evidence-based falls risk assessment instruments and interventions to reduce falls risk. T'ai chi, for example, can reduce falls risk by improving balance. The article describes a standard fall prevention program for older adults that can be part of a resident's care or service plan, criteria for an occurrence report, quality improvement monitoring, and a formula to calculate the residence's monthly falls rate.     

Fall prevention in frail elderly nursing home residents: a challenge to case management: part II

Parts I and II of this article examine the impact of a falls prevention program on the fall incidents among the residents in a nursing home. It was hypothesized that a diagnostic, therapeutic, and preventive approach should be used for nursing home residents identified as being at high risk for falls in order to reduce the number of fall incidents and to improve quality of life for this vulnerable population. The program effectively targeted both intrinsic and extrinsic factors to reduce risks facing the residents. The effectiveness of the program was evaluated by examining changes in the rate of falls after the program was implemented. The results identified that a multifaceted program, one that utilized multiple personalized interventions, was effective in reducing the falls rate of frail (those with complex medical and psychosocial problems) nursing home residents, and that muscle-strengthening interventions may be beneficial for this vulnerable population. Program outcomes verified that case managers can impact quality of life for frail elderly nursing home residents by promoting their independence and safety, and postponing problems resulting from inactivity. Part I (LCM, Nov-Dec 2001) discussed the background and process of a falls program and factors contributing to the occurrence of falls. This month we examine the interdisciplinary team approach to assessment, method, and implementing strategies for an effective fall prevention program. Tools used for prevention, monitoring, and investigation of falls are also detailed.     

Fall prevention in frail elderly nursing home residents: a challenge to case management: part I

Parts I and II of this article examine the impact of a falls prevention program on the fall incidents among the residents in a nursing home. It was hypothesized that a diagnostic, therapeutic, and preventive approach should be used for nursing home residents identified as being at high risk for falls in order to reduce the number of fall incidents and to improve quality of life for this vulnerable population. The program effectively targeted both intrinsic and extrinsic factors to reduce risks facing the residents. The effectiveness of the program was evaluated by examining changes in the rate of falls after the program was implemented. The results identified that a multifaceted program, one that utilized multiple personalized interventions, was effective in reducing the falls rate of frail (those with complex medical and psychosocial problems) nursing home residents, and that muscle-strengthening interventions may be beneficial for this vulnerable population. Program outcomes verified that case managers can impact quality of life for frail elderly nursing home residents by promoting their independence and safety, and postponing problems resulting from inactivity. Part I discusses the background and process of a falls program and factors contributing to the occurrence of falls. Part II will examine the interdisciplinary team approach to assessment, method, and implementing strategies for an effective fall prevention program. Tools used for prevention, monitoring, and investigation of falls will be detailed in Part II.     

Indoor Gateball’s Influence on Life Satisfaction and the Prevention of Falls by the Elderly

[Purpose] The purpose of this study was to investigate the effects of indoor gateball exercise on life satisfaction and the prevention of falls by the elderly. [Subjects] Sixteen elderly subjects aged 65 or more, residents in nursing care facilities, were randomly divided into two groups. [Methods] One group performed indoor gateball exercise for 30 minutes a day, five times per week. The Tetrax fall index and life satisfaction were measured before and after four weeks of gateball exercise. [Results] The indoor gate ball exercise group showed significant improvements in the fall index and life satisfaction. [Conclusion] The indoor gateball exercise used in this study should be considered as a therapeutic method for the elderly, for improving their life satisfaction and because of its effectiveness in preventing falls.     

高龄眼疾老年人跌倒风险的影响因素调查研究

目的:探究高龄眼疾老年人的跌倒风险及其跌倒风险相关的影响因素。方法:选取唐山市社区75岁及以上的有眼部疾患的老年人,进行修订版社区老年人跌倒危险评估工具评测。结果:412例高龄眼疾中老年人中存在跌倒风险者404人(98.1%),其中重度跌倒风险者140人(34.7%);近一年内跌倒者133人(32.3%),次数为1、2和≥3次者分别占22.6%、5.3%和4.4%;跌倒造成轻度损伤需医疗处置和严重损伤者分别占27.1%、9.8%。Logistic多元回归分析显示,日常生活能力、认知程度、平衡功能、视力、足部有无疾病、能否在家中安全行走、能否在社区内安全行走、居家环境危险因素是高龄眼疾老年人跌倒风险的影响因素,差异有统计学意义(P0.05)。结论:眼疾老年人的跌倒风险较大,影响其跌倒风险的因素复杂,应通过控制影响因素降低跌倒风险,实现健康老龄化。     

Current guidelines for using physiotherapy to prevent falls

Falls are one of the primary causes of reduced quality of life, disability, and mortality in the elderly. 90-100% of limb fractures in this population result from falls. Preventing falls is a difficult problem, and unfortunately not fully appreciated in Poland. One in three people aged 65 and over experience a fall at least once a year. In the case of community-dwelling individuals, 5% of falls lead to fractures, while among those living in nursing homes and hospitals this figure reaches 20%. Malfunctions of many internal organs and systems can contribute to falls, so that 400 different risk factors have been described; therefore, fall prevention should be multi-dimensional. At the current state of knowledge even a 40% decrease in fracture risk would be possible, provided that the patient is treated by a multidisciplinary team (family practitioner, rheumatologist, orthopedic surgeon, neurologist, physiotherapist, psychologist). Guidelines have already been developed on this subject in Europe and around the world. The present study reviews current opinions on osteoporosis and fall prevention, based on recent literature.     

A fall prevention program for the home environment

Falls are the leading cause of injury, death, and disability among people older than 65. When elders fall, they sustain such injuries as hip, spine, hand, and/or pelvic fractures. The prognosis after such a fall is poor--only half of older adults hospitalized for hip fractures are able to return home or live independently again. Even without injury, falls cause a loss of confidence that results in reduced physical activity, increased dependency, and social withdrawal. As a home care agency dealing with a geriatric population, our goal was to develop a user-friendly fall prevention program that would promote multidisciplinary assessment and intervention. We have developed a preventive approach through which clinicians and patients can collaborate on preventing falls in the home and maintaining our patients' first priority: quality of life.     

社区中危以上跌倒风险老年人护理干预效果的评价

目的探讨护理干预在预防社区中危以上跌倒风险老年人跌倒中的应用方法及效果。方法 2015年1-12月,采用便利抽样法选取上海市南码头街道某居委中危以上跌倒风险的老年人100例为研究对象,实施入户跌倒危险因素分析与个性化护理干预措施,采用老年人跌倒风险评估量表、跌倒预防知-信-行问卷及跌倒居家环境危险因素评估表对干预效果进行调查。结果干预后,社区中危以上跌倒风险老年人的跌倒发生率及跌倒风险评分低于干预前、跌倒预防知-信-行评分高于干预前、跌倒环境危险因素评分低于干预前,差异均有统计学意义(均P0.05)。结论个性化的跌倒危险因素分析与护理干预可以提高社区中危以上跌倒风险老年人的跌倒预防知-信-行,减少环境危险因素,有效预防跌倒的发生。     

Prevention of Slip and Fall Accidents: Risk Factors,Methods and Suggestions for Prevention

Abstract

Slips and falls are major causes of accidents and injuries at work, in public areas and at home. Studies have shown that the more risk factors an individual is exposed to, the higher risk for slips and falls. The aim of this paper is to describe risk factors for slips and falls, methods that can be used in prevention, and ideas on how physiotherapists can work with prevention of slip and fall accidents. A review of the literature has been done, searching for relevant literature published in English between 1985 and 2000, from the Medline catalogue. The result showed many different risk factors for slip and fall accidents: (a) transfer situations; (b) reduced postural control, i.e. disturbed balance together with reduced muscle strength in the lower extremity; (c) reduced mobility in the hips and feet; (d) dizziness and vestibular asymmetries; and (e) medication. The following diseases may increase the risk for slip and fall accidents: stroke, cardiovascular diseases, musculoskeletal disorders, depression, Parkinson's disease, diabetes and dementia. Preventive interventions have been described but more are needed. A standardized fall anamnesis has been described including patients' earlier fall accidents and relevant risk factors present. Walking ability, balance, medicine consumption can be registered. Preventive programmes concerning risk factors for slips and falls, physical activities for daily use, and preventive aids have been developed and can be recommended for use by patients visiting primary health care and occupational health care. Studies have shown that physical training can increase the number of activities in daily life, reduce the use of technical aids, increase balance and walking ability, which all reduce the risk for slip and fall accidents.