护理人员跌倒预防知识-态度-行为状况的调查研究

目的通过调查了解护理人员对住院老年患者跌倒预防相关知识、态度和行为的现况。方法采用方便抽样法,选择2011年1月-2012年4月于复旦大学附属华东医院工作的护士208名,用自行设计的跌倒预防知识、态度和行为评估问卷进行调查。结果护理人员对预防跌倒的知识平均分为（14．66±4．52）分;态度平均分为（30．24±3．97）分;行为平均分为（55．01±10。05）分。护理人员对跌倒预防的知识、态度和行为均与文化程度、职务、职称、年龄和培训经历有关,差异有统计学意义（P〈0．05）;护理人员对跌倒预防的知识与态度呈正相关（r=0．190,P〈0．05）;态度与行为呈正相关（r=0．380,P〈0．05）,知识与行为呈正相关（r=0．106,P〈0．05）。结论护理人员在跌倒预防的知识、态度和行为方面都有待提高;需加强对护理人员跌倒预防相关知识的培训,有助于提高护理质量,减少不良事件的发生。     

平衡指数测定在老年住院患者跌倒风险评估中的应用

目的 探讨平衡指数测定在老年住院患者跌倒风险评估中的应用.方法 选择2012年3-10月收治于上海交通大学医学院附属第三人民医院内科的老年患者500例作为实验组,选择2011年内科系统实施院内监控的防跌倒患者500例作为对照组,实验组患者根据平衡指数值选择预防监控,对照组采用院内定性评分给予监控.分析两组患者住院期间跌倒发生情况、伤害发生情况和监控情况;分析实验组平衡指数与跌倒发生率的相关性.结果 平衡指数测定可降低老年患者住院期间跌倒发生率（P＜0.05）;实验组实施监控人数与对照组比较,差异有统计学意义（P＜0.05）.结论 平衡指数测定是一种科学的可量化的跌倒风险评估工具,为老年住院患者跌倒的预防提供科学依据,降低跌倒发生率,并能提高护士工作质量和效率.     

Non‐pharmacological means to prevent fractures among older adults

Bone fractures affecting elderly people are a true public health burden, because they represent one of the most important causes of long‐standing pain, functional impairment, disability, and death among this population. Compromised bone strength (osteoporosis) and falling, alone, or more frequently in combination, are the two independent and immediate risk factors of elderly people's fractures through which all the other, more distant risk factors, such as aging, inactivity, poor nutrition, smoking, use of alcohol, diseases, medications, functional impairments, and disabilities, operate. Of these two, falling, not osteoporosis, is the strongest single risk factor for a fracture. The most usual occurrence resulting in a fracture of an older adult is a ‘simple’ fall from standing height or less. Although in general terms this type of trauma is mild or moderate only (compared with, for example, motor vehicle collisions), to the specific injury site these traumas are high‐impact injuries often creating forces clearly exceeding the breaking strength of the bone. Therefore, fractures affecting elderly people should be called ‘fall‐induced high‐impact injuries’ instead of the commonly used, partly misleading terms of osteoporotic fractures or minimal‐trauma fractures. Prevention of elderly people's fractures consists of prevention of osteoporosis and of falling, and prevention of fractures using injury‐site protection. Concerning osteoporosis, maximizing peak bone mass and preventing bone loss by regular exercise, calcium, and vitamin D, and, treatment of established osteoporosis with bone‐specific drugs, have a strong scientific basis. In fall prevention, regular strength and balance training, reducing psychotropic medication, and diet supplementation with vitamin D and calcium have been shown to be effective. The multifaceted risk factor‐assessing and modifying interventions have also been successful in preventing falls among the older adults by simultaneously affecting many of the risk factors of falling. Finally, concerning injury‐site protection, padded strong‐shield hip protectors whose effectiveness is scientifically proven seem to be a promising option in preventing hip fractures.     

Evaluation of hip fracture risk in relation to fall direction

The purpose of this study is to evaluate hip fracture risk in relation to fall direction, and to elucidate factors that influence the impact force in falls on the hip. Eight healthy volunteers performed deliberate falls in three directions (lateral, posterolateral and posterior) on a force platform covered by a mattress of 13 cm thickness. Fall descent motions and impact postures were examined by a three-dimensional analyzer. The maximum ground force reaction, velocity of the greater trochanter at impact, and activity of quadriceps and gluteus medius were measured. In all trials of lateral and posterolateral falls, but not of posterior falls, the subjects hit their greater trochanter directly on the mattress. The impact forces were between 2,000 N and 4,000 N. Posterolateral falls showed significantly higher velocity at impact than did posterior falls. The height and the lower limb length exhibited positive correlations with the impact force in all directions of fall. In the lateral fall, there was a positive correlation between the activity of quadriceps and the impact force. In view of the impact point, force, and velocity, the posterolateral fall seemed to carry the highest risk of hip fracture.     

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.     

Changes in motor activity and biomechanics during balance recovery following cutaneous and muscular deafferentation

The effects of lower limb deafferentation were examined during execution of a balance recovery step following a forward fall induced by release of an initial inclined posture. The subjects were healthy control subjects and patients with a unilateral loss of the Achilles tendon reflex following S1 radiculitis. Deafferentation of healthy subjects was obtained by unilateral leg ischemia (four subjects) and by foot anesthesia (five subjects). The balance recovery step was characterized by the surface electromyographic (EMG) activity of right and left soleus and tibialis anterior muscles and the kinetics of the center of gravity and center of foot pressure. Experimentally induced and pathological deafferentation decreased the EMG activity of the ipsilateral soleus and lowered the vertical ground reaction force. The lower limb motor activity was more affected by loss of muscle proprioceptive afferents than by loss of plantar cutaneous afferents. Patients showed early and bilateral changes in soleus and tibialis activities, whichever side was affected. The step length of patients was also shorter than that of controls, but it remained similar before and after deafferentation in the healthy subjects. The results are discussed in terms of ipsilateral and crossed pathway connections and functional adaptive strategies.     

On the Language and Logic of Psychophysiology: A Reply to Donchin

Donchin's critique of the paper by Schwartz and Pritchard illustrates several common faults in the use of language and logic. These include: 1. Inconsistent use of language and confusion in the use of theoretically meaningful terms; 2. The confusion of psychological and physiological domains, i.e., the use of psychological constructs as “explanations” in physiological theory and vice versa; 3. The tendency to be selective of data and explanations “justifying” a particular theoretical orientation without establishing criteria for the selections. For the study of electrical responses of the human brain to have significance for understanding information processing, theories must be founded in logical and consistent use of language, according to explicit decision criteria.     

FOCUS-PDCA程序在预防老年住院患者跌倒中的应用

目的：探导老年住院患者跌倒的原因和预防对策。方法：对老年住院患者运用FOCUS-PDCA程序找出跌倒常见原因及制定防治措施,包括成立防跌倒管理小组、对高危跌倒风险患者筛查、高危跌倒风险告知书及警示牌、对高危跌倒风险患者的防治措施、跌倒之后处理流程图、评价实施后的效果。结果：实行FOCUS-PDCA程序后,住院患者跌倒率由2.15%下降到0.49%,医疗护理质量得到了提高（P〈0.01）。结论：执行FOCUS-PDCA程序可以减少老年住院患者跌倒的风险。     

Association between energy cost of walking,muscle activation,and biomechanical parameters in older female fallers and non-fallers

Objective

To determine the nervous activation, muscle strength, and biomechanical parameters that influence the cost of walking in older fallers and non-fallers.

Methods

Maximal voluntary isokinetic torque was measured for the hip, knee and ankle of older women. Oxygen consumption was measured at rest and during 8 min of walking at self-selected speed. An additional minute of walking was performed to collect kinematic variables and the electromyographic signal of trunk, hip, knee, and ankle muscles, which was analyzed by the linear envelope. Cost of walking was calculated by subtracting resting body mass-normalized oxygen consumption from walking body mass-normalized oxygen consumption. Stride time and length, and ankle and hip range of motion were calculated from kinematic data.

Findings

Older adult fallers had 28% lower knee extensor strength (p = 0.02), 47% lower internal oblique activation at heel contact (p = 0.03), and higher coactivation between tibialis anterior and gastrocnemius lateralis in each of the gait phases (p < 0.05). For fallers, a higher activation of gluteus maximus was associated with a higher cost of walking (r = 0.55, p < 0.05 and r = 0.71, p < 0.01, before and after heel contact, respectively). For non-fallers, an association between cost of walking and age (r = 0.60, p = 0.01) and cost of walking and thigh muscle coactivation (r = 0.53, p = 0.01) existed.

Interpretation

This study demonstrated that there may be links between lower-extremity muscle weakness, muscle activation patterns, altered gait, and increased cost of walking in older fallers.