Incidence and Associated Factors for Single and Recurrent Falls among the Elderly in an Urban Community of Beijing

Objective To investigate the incidence of falls and recurrent falls, and explore associated factors for single and recurrent falls among urban community-dwelling elderly in Beijing. Methods A cross-sectional study was conducted in 472 elderly in the Longtan community of Dongcheng district, Beijing in 2009. Data regarding the incidence of fall and recurrent falls in the previous year, as well as associated factors were collected from the elderly through face-to-face interviews. Results The incidence of falls and recurrent falls was 17.8% and 6.1%, respectively, and it increased with age(χ2for trend=21.06, 19.20, P=0.001, 0.002). Binary logistic stepwise regression analysis showed that age(OR=2.20), living alone(OR=4.67) and gait disturbance(OR=1.27) were risk factors, while housing with elevators(OR=0.35), appropriate width/height of stair steps(OR=0.78), sufficient lighting for stairway(OR=0.45) and regular exercise(OR=0.12) could lower the risk for single fall; factors such as low monthly family income(OR=1.39), poor vision(OR=1.83), low physical ability(OR=4.47), abnormal static balance(OR=2.48), and fear of falls(OR=2.23) were risk factors, while appropriate width/height of stair steps(OR=0.49) and easiness of access to daily supplies(OR=0.41) were protective factors for recurrent falls. Conclusion The incidence of falls in community-dwelling elderly people in Beijing is common, and falls and their related injuries have been associated with both intrinsic and extrinsic factors.     

Falls and fall prevention in the elderly: the Jamaican perspective

Falls in the elderly may precipitate adverse physical, medical, psychological, social and economic consequences and are an issue of concern in both developed and developing countries. In Jamaica, there are no epidemiological studies on falls in the elderly though there is evidence to suggest that it is an issue that warrants some attention. This paper, through the use of quantitative and qualitative methods, provides insights on falls in the elderly in Jamaica. Through literature reviews, review of medicals records, and conducting focus group interviews, perspectives were gleaned on falls in elderly persons in Jamaica. Contributory risk factors and perceptions, and costs were explored, as were any existing fall prevention policies or policy thrusts. The emerging picture is that falls are not a rare occurrence among older persons in Jamaica and extrinsic factors such as poor road surfaces, poorly constructed steps and poor design of public transportation vehicles are factors that contribute to falls. Similarly, intrinsic factors related to co-morbid conditions such as hypertension, diabetes mellitus and sensory impairment appear to also contribute to increased risk of falling.     

高血压老年患者跌倒现状及相关因素分析

目的 调查高血压老年患者跌倒现状,并分析引起跌倒产生的相关因素,为制定有针对性预防护理措施提供支撑.方法 采取便利抽样方法,选取2011年1月至2015年12月在成都市第三人民医院VIP病房住院的高血压老年患者208例为研究对象,3个月内患者是否发生跌倒为观察指标,分析引起高血压老年患者跌倒的相关因素.结果 纳入208例高血压老年患者中,有78例(37.5%)3个月内至少跌倒1次.单因素分析结果显示:性别、降压药物、步态在跌倒发生方面差异有统计学意义(P<0.05).进一步Logistic回归分析结果显示:使用降压药物(OR=1.236,P<0.05)以及步态不稳(OR=3.127,P<0.05)是跌倒发生的危险因素.结论 高血压老年患者跌倒发生率较高,可能与使用降压药物及步态不稳相关,有必要加强护理干预和指导,预防跌倒发生.     

老年患者住院期间跌倒的危险因素分析及干预路径

目的探讨针对跌倒高危患者,尤其是老年患者,实施预防跌倒的临床干预路径的效果。方法选取2009年12月至2010年12月在老年科入院且年龄≥70岁的老年患者2442名,在入院时均使用《住院患者跌倒危险因素评估及护理措施表》进行评估,根据结果纳入1796例跌倒高危患者,按照预防跌倒的临床干预路径对其进行干预。干预措施包括及时记录评估结果;提供安全的住院环境和设施;针对性的健康教育;加强对跌倒高危患者的护理及关注,做好交接班;合理用药等。结果 1796例跌倒高危患者中仅有4例在住院期间发生跌倒,跌倒发生率为0.22%。造成院内跌倒的危险因素是:患者的性别、年龄、疾病、心理因素、服装;医院环境、设施、药物副作用、跌倒史等。结论通过加强对老年住院患者的跌倒危险因素评估,并针对危险因素及时实施预防跌倒的临床干预路径,可有效的防止老年患者跌倒的发生,减轻老年患者的痛苦。     

老年人跌倒致重型颅脑损伤的危险因素分析

目的 了解本地区老年人跌倒致颅脑损伤流行病学情况,分析老年人跌倒并发重型颅脑损伤的危险因素。 方法 回顾性分析2013年1月1日-2014年12月31日南昌市青云谱区内跌倒、且经"120"送至南昌市区内各医院住院治疗的77例老年患者的临床资料,研究对象纳入标准:①年龄 ≥ 60岁;②有明确跌倒致头部外伤史;③初始CT扫描明确外伤性颅脑损伤。排除标准:①年龄<60岁;②不符合颅脑损伤诊断标准;③颅脑损伤非跌倒所致。对其相关单因素采用χ2检验,将有意义的单因素纳入Logistic回归模型进行分析,统计软件采用SPSS 17.0。 结果 单因素分析显示,老年人跌倒致重度颅脑损伤与性别、入院时间、跌倒平面、相关枕颞着地、心脑血管基础病有关(P<0.05),与年龄、合并伤无关(P>0.05)。进一步对相关因素Logistic回归分析显示,心脑血管基础病(OR=5.555)、相关枕颞部着地(OR=4.420)是老年人跌倒致重型颅脑损伤的高危因素。 结论 对有心脑血管基础病、相关枕颞着地的跌倒致颅脑伤老年患者应密切观察病情变化,把握时机,尽早进行积极干预,以控制危险因素,减少继发脑损伤,降低重型颅脑损伤的发生率,改善愈后。老年人跌倒的社区宣教应有颅脑损伤的相关知识,加强颅脑损伤知识的宣教,提高老年人对颅脑伤的认识,预防老年人跌倒致重型颅脑伤的发生是必要的。      

社区老年人跌倒恐惧与健康自评的关系研究

背景　老年人跌倒恐惧是非常常见的现象，由此造成的肢体功能受限、生活质量下降、跌倒风险增加、医疗经济负担增加等不容忽视。健康状况自我评价是反映一个人健康状况以及死亡率的重要指标，其简单易行，可用于快速筛查和评估。国外已有一些健康自评和疾病关系的研究。但是目前我国关于此类的研究并不多见。目的　研究社区老年人跌倒恐惧的情况及其与健康自评的关系。方法　采用横断面设计，于2017年3-5月选取在北京市西城区牛街社区卫生服务站门诊就诊的老年人（年龄≥60岁），通过面对面问卷调查的形式进行数据收集。调查其过去1年跌倒发生情况，以及跌倒恐惧情况。采用世界卫生组织生存质量测定量表（WHOQOL），针对总体生活质量、健康状况、睡眠情况、日常生活能力、自我满意度、人际关系、朋友支持、居住地、卫生保健、交通情况以及消极情绪等进行自我评价。结果　共发放问卷410例，其中拒访2人，回收有效问卷408份。408名社区老年人中，267例（65.4%）存在跌倒恐惧，151例（37.0%）过去1年发生跌倒，发生跌倒的老年人中131例（86.8%）存在跌倒恐惧。跌倒恐惧者总体生活质量好、健康状况、睡眠情况、日常生活能力、自我满意度、人际关系、朋友支持、居住地、卫生保健、交通情况满意率低于无跌倒恐惧者，经常消极情绪发生率高于无跌倒恐惧者（P<0.05）。多因素Logistic回归分析结果显示，总体生活质量、健康状况、睡眠情况、日常生活能力、自我满意度、人际关系、朋友支持、居住地、卫生保健、交通情况自我评价不满意是老年人跌倒恐惧发生的危险因素（P<0.05），消极情绪自我评价偶尔出现是老年人跌倒发生的保护因素（P<0.05）。结论　跌倒恐惧与健康相关自我评价有关，有助于筛查跌倒恐惧高风险人群，以进一步采取相应的干预措施，以减少老年人跌倒恐惧，促进健康老龄化社会的建设。     

Falls in elderly

Falls are a major health problem among the elderly and an estimated 6% of falls by elderly result in fractures. Early identification of fall risk is likely to result in earlier implementation of intervention and to minimise development of secondary problems such as reduced confidence and activity levels. A comprehensive falls risk factor assessment should be performed for older people who present for medical attention after a fall, those who had more than one fall in the preceding year or those who have abnormalities of gait or balance. Falls are as a result of extrinsic risk factors, intrinsic risk factor or a combination of both. Syncope is defined as a transient, self limited loss of consciousness usually leading to a fall. Syncope and falls are often considered two separate entities with different aetiologies. Disorders affecting balance in the elderly are cerebral, cerebellar, spinal cord disorders; dementia; arrhythmias; postural hypotension; cerebrovascular disease; musculoskeletal/orthopaedic disorders; intervertebral disc disorders; psychological factors; visual impairment. Effective interventions include: (1) Health promotion and falls prevention. (2) Single interventions. (3) Medication review. (4) Exercise. (5) Home modifications. (6) To improve safety in the home. (7) To improve safety outside the home. Effective preventive strategies require better understanding of the causes of and risk factors for falling among elderly.     

社区老人跌倒和预防研究进展

跌倒是社区老年人伤害死亡的第1位原因,其危险因素包括老人自身、室内外环境、社会和行为因素。对引起老人跌倒的主要原因进行针对性的干预是预防跌倒的主要方法,研究证明身体锻炼、医疗干预、家庭设施的改进是预防跌倒的有效方法,联合干预措施被证明有效。预防老人跌倒应是目前公共卫生部门努力工作的目标。     

高龄脑梗死患者跌倒的危险因素分析及护理管理策略

目的探讨老年脑卒中患者意外跌倒的风险因素,分析并制订有效的护理对策,以防止老年脑卒中患者意外跌倒的发生。方法选取我院2007年1月～2011年6月收治的老年脑卒中患者84例,将其随机分为对照组（42例）和观察组（42例）。对照组仅进行常规教育,观察组进行跌倒风险评估同时采取防跌倒知识宣传,分析比较两组患者意外跌倒情况。结果晚22：00～早8：00为患者意外跌倒高发时段,跌倒地点多发生于病床边,受伤部位多为头部,60～70岁患者的跌倒频率最高,观察组意外跌倒发生率明显低于对照组,差异有统计学意义（P〈0.05）。结论全面评估老年脑卒中患者意外跌倒的风险因素,增加配套的安全设施,加强患者的安全教育和用药护理,制订科学、合理的护理对策和康复训练计划可以有效防止老年脑卒中患者意外跌倒的发生,是一种安全有效的治疗方法,值得临床推广使用。     

Approach to falls among the elderly in the community

One in three community-dwelling elderly aged ≥ 65 years and one in two aged > 80 years will have at least one fall within a year. Many elderly people are ‘silent fallers’ who do not report the fall nor seek medical assistance unless they are injured. In Singapore, falls account for 40% of injury-related deaths. Unaddressed risk factors for falls lead to recurrent falls and poor quality of life. Elderly people who have experienced falls and near falls can have a fear of falling, post-fall anxiety syndrome, depression and reduction in activities, with a negative impact on their well-being. Primary care doctors can screen and optimise modifiable risk factors such as poor vision, balance, poor gait, motor weakness, joint disorders, psychotropic drugs, sedatives, anti-hypertension medications, choice of footwear and environment factors. Timely referrals for cataract operations, balance and strengthening exercises, and osteoporosis treatment can reduce the risk of falls and injurious outcomes.     

跌倒效能在社区老年人肌肉减少症与生活质量的中介效应分析

目的 探讨跌倒效能在老年人肌肉减少症状与生活质量间的中介效应，为提高老年人的生活质量提供理论参考。方法 采用方便抽样法抽取辽宁省锦州市社区老年人610 名，运用肌肉减少症筛查量表、跌倒效能量表与生活质量量表对社区老年人进行调查。用SPSS 21.0 统计软件对于一般资料进行描述性分析，Pearson 相关分析对老年人肌肉减少状况、跌倒效能与生活质量间的相关程度进行分析；线性回归分析跌倒效能的中介作用；AMOS22.0 软件构建结构方程模型，Bootstrap 法进一步验证跌倒效能在社区老年人肌肉减少状况与生活质量间的中介作用。结果 有效回收问卷600 份，老年人肌肉减少状况、跌倒效能及生活质量之间均呈线性关系，肌肉减少得分与跌倒效能、生活质量得分呈负相关（P <0.05），跌倒效能得分与生活质量得分呈正相关（P <0.05）；跌倒效能在老年人肌肉减少与生活质量间发挥部分中介的作用，且中介效应占总效应的39.1%。结论 跌倒效能高的老年人生活质量较好，对于肌肉减少患者可以通过增加其跌倒效能来提高其生活质量。     

听力损失老年人跌倒的研究进展

全球老龄化程度不断加深的背景下,老年人听力损失的发病率越来越高。听力损失会限制老年人监测和感知空间方位的听觉线索能力,导致方向混乱,增加老年人跌倒的风险。本研究介绍了听力损失老年人跌倒的流行病学特征,阐述了其发生机制,包括神经病理学机制、感官剥夺机制、物理学机制,并通过梳理相关文献,总结了影响因素,包括年龄、性别、听力损失程度、听力损失性质、步态表现、助听设备的使用等,最后,提出听力损失老年人跌倒的防治对策。本研究发现,听力损失老年人跌倒发生情况占比增高,听力损失程度、年龄增长、老年女性激素水平改变、平衡能力下降、负性情绪等是听力损失老年人发生跌倒的危险因素,建议从助听设备使用和听觉康复训练、药物治疗、平衡能力评估和身体锻炼、心理干预4个方面对听力损失老年人跌倒进行防治,从而降低患者跌倒的发生率,保障其生活质量和生命安全。     

老年女性尿失禁患者生活质量及影响因素分析

目的 了解老年女性尿失禁(urinary incontinence,UI)患者生活质量和影响因素.方法 本研究采用整群抽样的方法,对北京市6个区养老院中642名符合条件的调查对象进行询问式的问卷调查.对其中244名不同类型UI患者进生活质量的测评,采用单因素和多因素方差分析处理数据.结果 患者的生活质量问卷平均得分为(...     

老年人坠落受伤致颅脑损伤死亡危险因素分析

目的探讨坠落方式对老年人颅脑损伤的影响并分析死亡的危险因素。方法回顾分析我院神经外科1996年1月～2010年12月共471例颅脑损伤患者的年龄、性别、受伤机制、伤后早期GCS评分、血压、瞳孔变化监测和CT扫描结果、治疗结果等数据并按排除标准排除后共有276例患者纳入作统计学分析。结果 276例中21%为坠落伤,其中12%坠落高度〉3m,另外9%〈3m。伤后2周病死率研究发现,〈3m的坠落伤病死率为31%,其它损伤病死率仅18%。严重颅脑损伤老年患者病死率明显高于其它年龄段。对于≥65岁的老年人坠落高度〈3m,其病死率达58%。结论在≥65岁的老年人,低空坠落伤是一个严重危险因素。避免≤3m低空伤,对降低老年人颅脑损伤病死率有明显影响。     

6Sigma-DMAIC理念管理法在老年住院患者跌倒风险预防中的应用研究

目的 研究6Sigma-DMAIC理念管理法在老年住院患者跌倒风险防控管理中的应用,为降低老年住院患者跌倒发生率提供参考依据。方法 选择2019年3月—2020年9月于温州医科大学附属第二医院住院治疗的216例老年患者作为观察对象,按随机数字表法分为对照组和研究组,每组各108例。对照组患者在住院治疗期间接受常规跌倒预防干预措施;研究组患者在常规干预基础上实施基于6Sigma-DMAIC理念管理法的防范措施,统计老年住院患者的跌倒原因,比较2组患者对跌倒防范知识的掌握程度、跌倒发生率及患者对临床干预管理措施的满意度。结果 研究组患者对预防跌倒知识、跌倒处理知识、防跌倒设施、防跌倒技巧的掌握程度均高于对照组,差异有统计学意义(均P<0.05);研究组患者住院期间跌倒总发生率为0.93%(1/108),低于对照组的7.41%(8/108),差异有统计学意义(P<0.05);研究组患者对跌倒预防管理总满意度为97.22%(105/108),明显高于对照组的87.04%(94/108),差异有统计学意义(P<0.05)。结论 6Sigma-DMAIC理念管理法在老年住院患者跌...     

Characteristics associated with falls among the elderly within aged care wards in a tertiary hospital: a retrospective

Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics. Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group： Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident Information Management System （IIMS）. Further details about the particular admission（s） were obtained from patients＇ medical records, e.g., patients＇ characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-railers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients＇ room and 18.9% in patients＇ bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9：00-11：00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination （MMSE） score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall. Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main causes leading to fall were intrinsic factors. For patients with cognitive impairment/dementia and behavioral disorder providing special and effective interventions is of paramount importance for reducing the incidence of fall in an aged care ward in hospital settings.     

Low prevalence of postural hypotension among community-dwelling elderly

Postural hypotension (PH) has a prevalence of about 20% in most large studies of elderly individuals; however, these studies do not exclude subjects with diseases and medications known to cause PH. We sought to determine the prevalence of PH in healthy, community-living, elderly individuals in contrast to those with known risk factors for the condition. We measured supine and one-minute standing blood pressures in 300 independently living elderly persons who visited a senior citizen health screening program. Subjects were divided into two groups: those with known risk factors (n = 175) and those without (n = 125). The prevalence of PH (systolic decrease, greater than or equal to 20 mm Hg) for for the entire population was 10.7%. In the group with risk factors, the prevalence was 13.7% (24/175), compared with 6.4% in the group without risk factors (8/125). Supine hypertension was associated with PH, but there was no relationship between the presence of PH and age, history of falls, symptoms on standing, or recent meal. These data suggest that PH is a relatively uncommon finding in healthy elderly, its prevalence is significantly related to risk factors, and its association with falls or symptoms may be less than previously reported.     

Characteristics associated with falls among the elderly within aged care wards in a tertiary hospital: a retrospective case-control study

Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics.Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group: Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident information Management System (IIMS). Further details about the particular admission(s) were obtained from patients' medical records, e.g., patients' characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-fallers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients' room and 18.9% in patients' bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9:00-11:00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination (MMSE) score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall.Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main causes leading to fall were intrinsic factors. For patients with cognitive impairment/dementia and behavioral disorder providing special and effective interventions is of paramount importance for reducing the incidence of fall in an aged care ward in hospital settings.     

Characteristics associated with falls among the elderly within aged care wards in a tertiary hospital: a retrospective case-control study

Background Falls are the most frequently reported adverse events in inpatient settings. We conducted a retrospective case-control study of inpatient falls within aged care wards in a tertiary hospital to investigate the associated characteristics of elderly patients suffering from falls and fall-related characteristics.Methods Consecutive retrospective cross-sectional design spanned July 2006 to December 2008. Patient group: Information on all aged care inpatients who suffered from 1 or more falls was extracted from Incident information Management System (IIMS). Further details about the particular admission(s) were obtained from patients' medical records, e.g., patients' characteristics and circumstances surrounding the falls. Randomly selected aged care patients who did not suffer from a fall and who were discharged from the hospital in the same period served control group. Characteristics among patients with single fall and recurrent falls, as well as non-fallers were compared. Results Of the 438 falls evaluated, 71.9% occurred in patients' room and 18.9% in patients' bathroom/toilet. The common activities were moving/transferring and taking shower/toileting, respectively, 70.3%, 12.1% while occurring falls; and time of falls had a high peak during 9:00-11:00 a.m. Many were unassisted while falling. The common contributing factors for fall were intrinsic factors. Patients with recurrent falls were more likely to have lower Mini-Mental State Examination (MMSE) score. Logistic regression analysis showed length of stay longer than five weeks, dementia and stroke were independent risk factors for recurrent falls; and living in hostel/nursing home preadmission, needing assistance with mobility, cognitive impairment, stroke, incontinence and arthritis/osteoporosis were independent risk factors for fall.Conclusions In an aged care ward, falls are independently associated with recurrent factors. Cognitive impairment/dementia was a strong risk factor for falls, and main causes leading to fall were intrinsic factors. For patients with cognitive impairment/dementia and behavioral disorder providing special and effective interventions is of paramount importance for reducing the incidence of fall in an aged care ward in hospital settings.     

A Small-Area Study of Environmental Risk Assessment of Outdoor Falls

Falls in public places are an issue of great health concern especially for the elderly. Falls among the elderly is also a major health burden in many countries. This study describes a spatial approach to assess environmental causes of outdoor falls using a small urban community in Hong Kong as an example. The method involves collecting data on fall occurrences and mapping their geographic positions to examine circumstances and environmental evidence that contribute to falls. High risk locations or hot spots of falls are identified on the bases of spatial proximity and concentration of falls within a threshold distance by means of kernel smoothing and standard deviational ellipses. This method of geographic aggregation of individual fall incidents for a small-area study yields hot spots of manageable sizes. The spatial clustering approach is effective in two ways. Firstly, it allows visualisation and isolation of fall hot spots to draw focus. Secondly and especially under conditions of resource decline, policy makers are able to target specific locations to examine the underlying causal mechanisms and strategise effective response and preventive measures based on the types of environmental risk factors identified.