老年髋部骨折患者术后谵妄发生的危险因素分析

目的探讨老年髋部骨折患者术后谵妄发生情况及危险因素分析。方法选取2014年12月～2019年1月我院接受手术治疗的180例老年髋部骨折患者作为研究对象,根据住院期间谵妄发生情况,分为谵妄组与非谵妄组,采用多因素Logistic回归分析老年髋部骨折患者术后谵妄发生的危险因素。结果 180例患者住院期间发生谵妄42例,发生率23.33%;多因素Logistic回归分析显示,术后机械通气、HAMA≥14分、使用咪达唑仑、PaO283mmHg是老年髋部骨折术后谵妄的危险因素。结论老年髋部骨折术后谵妄发生率较高,术后采用机械通气、焦虑情绪、使用咪达唑仑、PaO2低等均会增加谵妄发生风险。     

老年脑卒中患者长期随访期间髋部骨折的危险因素研究

目的观察老年脑卒中患者长期随访期间髋部骨折的发生特点,并对其危险因素进行研究。方法选择453例老年脑卒中患者为研究对象,获得完整随访资料383例,根据随访期间是否发生髋部骨折分为骨折组和非骨折组,对2组认知功能水平、神经功能受损严重程度、视力情况(视力正常、视力受损)、平衡情况、起立-行走运动功能、运动执行功能、谈话时停止行走能力进行检测。同时对脑卒中后髋部骨折的危险因素进行Logistic回归多因素分析。结果 383例脑卒中患者在随访期间发生髋部骨折22例,发生率5.7%;经多因素Logistic回归分析发现,MMSE评分较低、视力受损、起立-行走运动功能受损、SWWT阳性、既往骨折史均为老年脑卒中后髋部骨折的危险因素(P0.05)。结论老年脑卒中髋部骨折的发生率较高,且认知功能低下、视力受损、起立-行走运动功能受损、SWWT阳性、存在既往骨折史的老年脑卒中患者髋部骨折发生概率较大。     

老年期情感性精神障碍患者自杀危险因素的随访研究

目的 探讨老年期情感性精神障碍患者自杀的危险因素。方法 采用队列内病例对照研究方法，对符合中国精神疾病分类方案与诊断标准第2版修订本中情感性精神障碍诊断标准出院的72例老年患者，进行为期6－7年的随访、自杀危险因素的单因素分析和非条件Logistic回归分析。结果 18例（25％）患者发生过自杀，其中自杀未遂15例（21％），自杀死亡3例（4％）。自杀危险因素为双相昆合或快速循环型、频繁发作和自杀未遂史，保护因素为多次住院。结论 有潜在自杀危险因素的老年情感性精神障碍患者应加强自杀的预防，住院为有效的预防措施之一。     

老年患者脑卒中后吞咽障碍危险因素及临床特点分析

目的探讨老年脑卒中患者吞咽障碍的发生率及危险因素。方法回顾性分析2011-05—2011-12入住我院神经内科、年龄≥65岁急性脑卒中患者127例,分为吞咽障碍组70例,无吞咽障碍组57例,分析吞咽障碍的发生率及危险因素。结果老年患者卒中后吞咽障碍发生率为55.11%。Logistic回归分析显示,年龄≥80岁,美国国立卫生研究院卒中量表评分≥12分、格拉斯哥昏迷评分≤10分、脑干梗死是吞咽障碍的危险因素。吞咽障碍组住院期间发生肺炎21例(30.00%),无吞咽障碍组发生肺炎5例(8.77%)。吞咽障碍组肺炎发生率明显高于无吞咽障碍组(P<0.01)。结论老年卒中患者容易发生吞咽障碍,肺炎发生率也相应增加,临床医师应高度重视老年脑卒中患者吞咽障碍的预防和治疗。     

武汉市武昌区重性精神疾病患者现状及相关因素分析

目的：了解武汉市武昌区重性精神疾病患者的现状与相关因素之间的关系,为社区有效管理提供依据。方法资料来源于国家重性精神疾病网络管理系统,对武昌区3358例重性精神疾病患者的相关数据进行描述性分析,对患者病程及疾病类型的影响因素进行 Logistic 回归分析。结果武昌区网络管理的重性精神疾病患者中单身者占59．38％,初中及以下文化程度者占60．18％,家庭经济状况贫困者占43．33％,无业或下岗者占60．76％。Logistic回归分析发现,经济状况（OR ＝0．896）、文化程度（OR ＝1．430）会影响病程;文化程度（OR ＝0．549）、经济状况（OR ＝1．212）、婚姻（OR ＝1．183）、职业（OR ＝1．215）会影响精神疾病类型。结论应将精神分裂症、精神发育迟滞（伴发精神障碍）作为管理重点,尤其是对未服药及依从性差的患者。     

氯氮平的心脏不良反应

目的：探讨氯氮平治疗精神疾病时的心脏不良反应及危险因素。方法：分析400例服用氯氮平治疗的患者心电图异常改变及其影响因素。结果：服用氯氮平的患者中出现窦性心动过速(发生率79％)、心律失常及传导障碍(4、5％)、ST段压低(3、8％)、T波异常(36．5％)、QTc间期延长(16．3％)等心电图异常。其严重异常发生率为24．3％。服氯氮平出现心脏严重不良反应的危险因素有：男性、合并心血管疾病、治疗前T波异常、服药剂量较大、服药早期。结论：氯氮平的心脏不良反应较常见，约1／4患者可出现严重心电图异常。氯氮平不宜作为首选用药，使用时应定期监测心电图。     

研究生罹患精神疾病的调查

目的：首次比较准确地评价在读研究生群体罹患精神疾病情况，同时对其患病影响因素进行了初步分析。方法：采取整群随机抽样的办法对828名研究生进行精神疾病调查，采取病例对照研究分析了性别等6种因素对研究生神经症的影响。结果：研究生精神疾病患病率11．47％；研究生最常见精神疾病是神经症（8．57％）、心因性障碍（1．81％）和人格障碍（0．60％）；研究生神经症最常见亚型是强迫症（3．50％）、神经衰弱（2．66％）和恐怖症（0．72％）；男生（OR＝2．53）、非独生子女（OR＝2．32）和工学专业（OR＝2．20）是研究生神经症的危险因素，医学专业（OR＝0．40）是保护因素。结论：有1／10以上的研究生患有精神疾病，他们的心理健康状况需要高度重视；研究生精神疾病的患病情况和危险因素有群体自身的特点。     

住院精神病患者病房内跌倒调查分析及护理对策

目的分析精神病患者病房内跌倒情况及其危险因素,寻求有效防范措施,减少意外发生。方法回顾性调查我院2001～2006年住院的138例精神病患者病房内跌倒发生情况。结果精神分裂症患者、精神疾病伴发躯体疾病、老年人生理机能衰退为跌倒的主要风险因素,并造成不同程度损伤。结论跌倒在精神科病房中常发生,且带来严重后果,应予重视。     

具有凶杀行为的精神疾病患者自杀行为研究

目的:探讨具有凶杀行为的精神疾病患者自杀的危险因素。方法:调查1986年至2006年具有凶杀行为的精神疾病患者院内自杀身亡31例,采用多因素Logistic回归分析自杀行为危险因素。结果:具有凶杀行为精神疾病患者自杀男:女=3.43∶1,自杀行为的发生与家族自杀史、悔恨、绝望、心理社会因素及杀害对象有关。结论:悔恨、绝望、心理社会因素等是具有凶杀行为精神疾病患者自杀的危险因素,对于有凶杀行为的精神疾病患者自杀行为应加以干预。     

难治性抑郁症危险因素的对照研究

目的探讨难治性抑郁症的相关危险因素，为临床防治提供客观依据。方法将160例符合难治性抑郁症标准的抑郁症与同期的非难治性抑郁症进行1：1配比病例对照研究，应用条件Logistic回归分析方法处理数据。结果多因素条件Logistic回归分析表明难治性抑郁症的危险因素是：双相情感障碍(OR=3．678，95％CI：1.805-7．321)，神经质(OR=4．459，95％CI：1．790-10．889)，伴有精神病性症状(OR=4．361，95％CI：2．183-8．410)，情感疾病家族史(OR—0．367，95％CI：0．019-0．916)，一年内未及时治疗(OR-0．408，95％CI：0．207-0．829)。结论具有双相情感障碍、神经质、伴有精神病性症状、情感疾病家族史、一年内未及时治疗是难治性抑郁症的重要危险因素。     

Risk factors for falling in a psychogeriatric unit

OBJECTIVE: To identify risk factors associated with falls in a psychogeriatric inpatient population. DESIGN: Retrospective cohort study. SETTING: A psychogeriatric inpatient unit in a Brown University affiliated psychiatric hospital. PARTICIPANTS: A total of 1834 men and women who represented all admissions to the psychogeriatric inpatient unit between January 1992 and December 1995. RESULTS: Over the study period a total of 175 falls were recorded, giving a fall rate of 9.5%. Using a logistic regression model, six variables were found to be independently associated with an increased risk of falling: female gender, electroconvulsive therapy (ECT), mood stabilizers, cardiac arrhythmias, Parkinson's syndrome and dementias. Falls and ECT were associated with longer hospital stay, when adjusted for confounders including ECT. CONCLUSIONS: These findings support previous results and identify ECT as a possible risk factor for falling in a hospital setting.     

Multivariate prediction of falls in elderly inpatients

One hundred and forty falls sustained by 65 psychogeriatric inpatients of average age 77.1 were studied in an attempt to identify risk factors. Multivariate analysis revealed increased age, a diagnosis of dementia and use of tricyclic antidepressants to be positively associated with falls when comparison was made to a control group of patients treated on the same unit who did not fall. Use of high-potency neuroleptics was negatively associated with falls in the same analysis. A second analysis failed to reveal any variables, including routine daily measurements of orthostatic change in blood pressure, to be associated with rate of falling within the group of fallers.     

Causes and risk factors of falls in patients with Parkinson's disease

BACKGROUND AND PURPOSE: Falls are a common and serious problem among Parkinson's disease (PD) patients. However, knowledge about the causes and risk factors of falls is limited. There have been a few attempts to classify the causes of falls. The classification suggested by Olanow seems to be the most comprehensive one. The aim of this study was to analyze retrospectively the causes of falls and risk factors of falls in PD patients. MATERIAL AND METHODS: One hundred and four patients with moderately advanced PD were included in the study. The patients were asked to describe the circumstances and consequences of falls which occurred during 12 months preceding the examination. The falls were classified according to the Olanow classification of causes of falls. RESULTS: Fifty-two patients (50%) reported at least one fall during the previous year with a mean number of 1.5 falls per year. The most common causes of falls were environmental factors, sudden falls and postural instability. There were no falls caused by severe dyskinesia, drugs or cardiovascular disorders. The only independent risk factors of the recurrent falls identified in this study were UPDRS part II score (OR 1.17, 95% CI: 1.02-1.37) and Mini Mental State Examination score (OR 0.85, 95% CI: 0.72-0.99). CONCLUSIONS: Considering these results we may be able to prevent most falls by means of the education of patients about environmental factors and using adequate rehabilitation techniques concentrating on postural stability and gait.     

The incidence and risk factors of falls in Parkinson disease: prospective study

Background and purposeAlthough Parkinson disease (PD) patients suffer falls more frequently than other old people, only a few studies have focused on identifying the specific risk factors for falls in PD patients. The aim of this study was to assess the incidence and risk factors of falls in a prospective study in comparison to a control group.Material and methodsOne hundred patients with PD were recruited to the study along with 55 gender- and age-matched healthy controls. Both groups were examined twice; the second examination took place one year after the first one. Examination of the PD group included: medical history including falls, neurological examination, assessment of the severity of parkinsonism [Unified Parkinson's Disease Rating Scale (UPDRS), Schwab and England scale (S&E), Hoehn and Yahr scale (H&Y), Mini-Mental State Examination (MMSE)], Hamilton scale and quality of life scales (SF-36, EQ-5D) and Freezing of Gait Questionnaire (FOG-Q). In both groups falls were recorded over the 12 months. Frequent fallers are defined as having more than 3 falls a year.ResultsOver the year falls occurred in 54% of PD patients and 18% of controls. In a prospective study 28% of PD patients fell more frequently than in retrospective analysis. Frequent fallers were found in 20% of patients and in 7% of controls. Fallers showed higher scores in UPDRS, H&Y, S&E, MMSE, and Hamilton scale than non-fallers. Independent risk factors for falls were: age, previously reported falls and higher score in the FOG-Q.ConclusionsFalls in PD patients occurred three times more frequently than in controls. Independent risk factors for falls were: high score in FOG-Q, older age and presence of falls in medical history.     

Lack of association between plasma homocysteine and inflammation in psychogeriatric patients

Background/Objectives: In previous studies we observed a high incidence of elevated plasma homocysteine (tHcy) concentrations in psychogeriatric patients. Plasma tHcy is increased in folate deficiency. Folates are sensitive to oxidative stress. Oxidative stress, caused by inflammatory processes, could represent an endogenous reason for folate deficiency, even when the dietary intake of the vitamin is within the recommended range. It has been suggested that oxidative stress rather than insufficient folate intake causes hyperhomocysteinemia in different forms of psychogeriatric diseases. In the present study we investigated the association between plasma tHcy and C-reactive protein (CRP), a sensitive marker for inflammation, in psychogeriatric patients. Methods: Plasma tHcy, its main determinants, and CRP were measured in plasma and serum of 132 psychogeriatric patients (53 males and 79 females, mean age 75 +/- 12 years). Results: In the psychogeriatric patients, plasma tHcy was elevated and blood folate and serum creatinine were lower than in control subjects, whereas serum CRP concentrations did not differ significantly. We also subdivided the psychogeriatric patients into different diagnosis groups, yet there were no differences in serum CRP concentrations in these groups compared with age-matched control groups. There was a significant correlation between plasma tHcy and serum CRP (rho = 0.19, p < 0.05). A stepwise multiple regression analysis including serum CRP, age, blood folate, serum cobalamin, serum methylmalonic acid and serum creatinine showed that only blood folate (p < 0.001), age (p < 0.001), serum creatinine (p < 0.001), serum cobalamin (p < 0.001), and serum methylmalonic acid (p < 0.001) independently predicted plasma tHcy concentration. Thus CRP concentration was not an independent predictor of plasma tHcy. Conclusion: The present study did not show any association between inflammatory status and plasma tHcy concentration in psychogeriatric patients.     

Postural sway and falls in Parkinson's disease: a regression approach.

A population-based study was designed to evaluate the clinical associates of postural sway and to identify the risk factors for falls in Parkinson's disease (PD). From a total population of 205,000 inhabitants, 215 PD patients were identified of which 120 home-dwelling cases were finally included in the study. Medical data were collected and patients were clinically examined and tested for static balance using an inclinometric device. Recent falls occurred in 40 (33%) of the subjects and 27 (23%) subjects were recurrent fallers. The fallers had a significantly larger sway area (P = 0.021) and a larger maximum deflection in anterior-posterior (P = 0.016) and lateral directions (P = 0.006) than the nonfallers. A significant correlation was found between the sway measures and the UPDRS total score, motor subcore and UPDRS "bradykinesia" item. A higher UPDRS total score (OR: 1.04, 95% CI: 1.01-1.07) and an increased sway area (OR: 1.25, 95% CI: 1.02-1.54) were independent risk factors for recent falling in PD. In addition, the duration and severity of PD, antiparkinsonian medication, recent falling and the use of a walking aid were associated with increased sway measures. The results can be used to identify PD patients who are at a risk of falling. Both antiparkinsonian medication and nonmedical treatment should be optimized to reduce falls in PD.     

Beyond to pattern of risk factors in elderly subjects

Most falls in the elderly result from an interaction between several risk factors in. Interventions targeting risk factors for a fall have been effective in the prevention of falls. The aim of this prospective study was to identify pattern of risk factors in hospitalized elderly subjects for fall in a geriatric acute care unit. Methods: over a 5-year period, 471 patients hospitalized in the geriatric unit of Angers Hospital following a fall were randomly assigned to 471 patients without any fall history. The prevalence of risk factors for a fall, and the existence of predisposing and precipitating factors were compared between the two groups. Results: risk factors for fall, namely gait unsteadiness, hip disorders, peripheral neuropathy, convulsions and syncope, were significantly more prevalent in the group of fallers compared to the controls. Two faller patterns were proposed: (1) patients with depression and receiving benzodiazepine and neuroleptic, and (2) patients with poor vision and osteoarticular disorders. Two further factors, namely parkinsonism and foot disorders, seemed to be sufficient to explain a fall. Conclusion: this study for the first time has identified risk factors patterns of fall in elderly patients hospitalized in a geriatric acute care unit, which can be used to implement diagnosis and treatment strategies.     

The association between decreasing length of stay and readmission rate on a psychogeriatric unit.

OBJECTIVE: This study investigated whether there was an association between decreasing length of stay and readmission rate on a psychogeriatric unit. METHODS: Discharge summaries were reviewed for all 1,099 admissions to a university hospital psychogeriatric unit from January 1993 through December 1997. Data were collected for all 77 patients who were readmitted within 30 days of a previous discharge and for an equal number of randomly selected patients who were not readmitted. Data included length of stay, diagnosis, disposition, and demographic information. RESULTS: Mean length of stay decreased significantly over the five-year study period for patients who were readmitted and for those who were not readmitted. The mean length of stay for the index admission of readmitted patients decreased from 33.6 days to 9.5 days. The mean length of stay of patients who were not readmitted decreased from 27.5 days to 12.7 days. Over the same period, the readmission rate doubled, rising from 5.3 percent (seven patients) to 10.8 percent (30 patients), and the proportion of patients who were discharged to the geriatric day hospital increased significantly. CONCLUSIONS: Although it is difficult to demonstrate causality, these findings indicate a temporal association between decreasing length of stay and rate of readmission to a university hospital psychogeriatric unit.     

Falls among community-dwelling psychogeriatric patients

Although increasing interest has been focused on falling in the elderly, little is known about the incidence and consequence of falls in psychogeriatric outpatients. We conducted a 1-year prospective study of falling in 102 community-dwelling elderly patients with psychiatric morbidity (mean age: 70 years) and 100 mentally intact elderly patients (controls, mean age: 74 years). The subject group comprised 79 patients with depression, 14 with dementia and nine with combined disease based on DSM-III-R criteria. Overall, 216 falls in the subject group and 54 in the controls were reported. At the end of the study, recurrent fallers aged 75 years and older showed significant physical deterioration. Multiple logistic regression analysis of selected medical and demographic variables indicated that the most influential variable regarding falling of the subjects was severity of depression rated using the Hamilton scale. Unexpectedly, the analysis revealed that the use of antidepressants was associated with a lower likelihood of falling. On the basis of the two variables, 75% of all respondents were correctly classified as fallers or non-fallers.     

Risk factors for falls among residents with dementia living in group dwellings

BACKGROUND: Falls are a major cause of morbidity and mortality among elderly people, and people with dementia run an increased risk of falling. The aim of this study is to identify risk factors for falls in people with dementia. METHOD: The study was performed over a six-month period in northern Sweden using a sample of 160 residents living in 20 group dwellings for people with dementia. RESULTS: Sixty-four residents (40%) sustained at least one fall during the period. The total number of falls during the study period was 191, and the fall incidence was 2.6 per person year (169 falls/130 residents). Using logistic regression analysis, the independent risk factors strongly associated with falling were: requiring help with hygiene, displaying verbally disruptive/attention-seeking behavior, able to rise from a chair, walking with assistive devices, and participating in outdoor walks. These factors explained 36.1% of the variance in falls with a concordance of 79.6%. Thirty-five percent of the falls occurred between 9 pm and 6 am, with a peak between 5 pm and 6 pm. Symptoms preceding the falls were anxiety (31.1%) and confusion (13.3%). CONCLUSION: Among residents with dementia it is important to identify those who run an increased risk of falling and need more careful supervision, especially in the evening and during the night. In addition, the causes of anxiety and confusion have to be prevented and treated.