养老机构老年人跌倒效能及其影响因素研究
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摘要
背景害怕跌倒在养老机构和住院老年人中发生率高。由于害怕跌倒,老年人会自我强加活动限制,形成久坐不动的生活方式,从而使其身体功能下降,增加跌倒、社会隔离、焦虑、抑郁以及住院的发生。目的调查成都市养老机构老年人跌倒效能现状及其影响因素。方法 2017年8—9月,采用便利抽样法,应用一般资料问卷、修订版跌倒效能量表、Barthel指数评定量表、老年人跌倒环境安全因素评估表和健康调查12条简表(SF-12)对成都市3所养老机构的300名老年人进行问卷调查。采用多元线性逐步回归分析养老机构老年人跌倒效能的影响因素。结果回收有效问卷278份,有效回收率为92.7%。老年人跌倒效能得分为(106.62±34.22)分。多元线性逐步回归分析结果显示:过去1年内有无跌伤史、日常生活中有无活动限制、有无老伴一同入住养老机构、24 h睡眠时间、Barthel指数得分、老年人跌倒环境安全因素评估表的室内卫生间维度评分及SF-12的躯体健康评分和心理健康评分是其跌倒效能的影响因素(P<0.05)。结论成都市养老机构老年人的跌倒效能处于中等水平,可针对不同的老年人制定相应的干预措施,以提高其跌倒效能,从而预防跌倒。
Background The incidence of fear of falling is high among the elderly in nursing homes and inpatient department.Because of fear of falling,the elderly may impose restrictions on their activities and form a sedentary lifestyle,which will reduce their physical function and increase the probability of falling,social isolation,anxiety,depression and hospitalization.Objective To investigate the fall efficacy and its influencing factors among the elderly in nursing homes in Chengdu.Methods A total of 300 elderly people from 3 nursing homes in Chengdu were selected by convenience sampling method from August to September,2017.General information questionnaire,Modified Fall Efficacy Scale,Barthel Index Scale,Elderly Fall Environmental Safety Factor Scale and the 12-items Short Form Health Survey(SF-12)were used to investigate subjects.Multivariate linear stepwise regression analysis was used to analyze the influencing factors of fall efficacy of the elderly in nursing homes.Results A total of 278 questionnaires were collected,with effective recovery rate of 92.7%.The elderly fall efficacy were(106.62±34.22)points;Multiple linear stepwise regression analysis showed that fall history in the past one year,activity restriction in daily life,living with or without spouse,24-hour sleep time,Barthel index score,toilet environment score of Elderly Fall Environmental Safety Factor Scale,PCS score and MCS score of SF-12 were influencing factors of fall efficacy among the elderly.Conclusion The fall efficacy of the elderly in nursing homes in Chengdu is moderate.Individualized intervention should be formulated for different elderly to improve their fall efficacy,thus preventing falls.
Background The incidence of fear of falling is high among the elderly in nursing homes and inpatient department.Because of fear of falling,the elderly may impose restrictions on their activities and form a sedentary lifestyle,which will reduce their physical function and increase the probability of falling,social isolation,anxiety,depression and hospitalization.Objective To investigate the fall efficacy and its influencing factors among the elderly in nursing homes in Chengdu.Methods A total of 300 elderly people from 3 nursing homes in Chengdu were selected by convenience sampling method from August to September,2017.General information questionnaire,Modified Fall Efficacy Scale,Barthel Index Scale,Elderly Fall Environmental Safety Factor Scale and the 12-items Short Form Health Survey(SF-12)were used to investigate subjects.Multivariate linear stepwise regression analysis was used to analyze the influencing factors of fall efficacy of the elderly in nursing homes.Results A total of 278 questionnaires were collected,with effective recovery rate of 92.7%.The elderly fall efficacy were(106.62±34.22)points;Multiple linear stepwise regression analysis showed that fall history in the past one year,activity restriction in daily life,living with or without spouse,24-hour sleep time,Barthel index score,toilet environment score of Elderly Fall Environmental Safety Factor Scale,PCS score and MCS score of SF-12 were influencing factors of fall efficacy among the elderly.Conclusion The fall efficacy of the elderly in nursing homes in Chengdu is moderate.Individualized intervention should be formulated for different elderly to improve their fall efficacy,thus preventing falls.
引文
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[8]陈瑜,姜小鹰,杨美丽,等.养老机构老人跌倒效能状况及其影响因素分析[J].中国实用护理杂志,2016,32(6):412-415.DOI:10.3760/cma.j.issn.1672-7088.2016.06.004.CHEN Y,JIANG X Y,YANG M L,et al.Investigation on the fall efficacy of elderly people in nursing homes and its influencing factors[J].Chin J Prac Nurs,2016,32(6):412-415.DOI:10.3760/cma.j.issn.1672-7088.2016.06.004.
[9]张栋.北京市老年人机构养老意愿及影响因素研究[J].调研世界,2017,30(10):23-29.DOI:10.13778/j.cnki.11-3705/c.2017.10.004.ZHANG D.Study on the willingness and influence factors of elderly people in nursing homes in Beijing[J].The World of Survey and Research,2017,30(10):23-29.DOI:10.13778/j.cnki.11-3705/c.2017.10.004.
[10]许贤豪.神经心理量表检测指南[M].北京:中国协和医科大学出版社,2007:17.
[11]中华人民共和国民政部.中华人民共和国民政行业标准MZ/T 039-2013老年人能力评估[S/OL].[2019-01-05].http://images3.mca.gov.cn/www/file/201703/1490939975354.pdf.
[12]TINETTI M E,RICHMAN D,POWELL L.Falls efficacy as a measure of fear of falling[J].J Gerontol,1990,45(6):239-243.DOI:10.1093/geronj/45.6.p239.
[13]HILL K D,SCHWARZ J A,KALOGEROPOULOS A J,et al.Fear of falling revisited[J].Arch Phys Med Rehabil,1996,77(10):1025-1029.DOI:10.1016/s0003-9993(96)90063-5.
[14]包月.老年公寓老人害怕跌倒心理及影响因素的研究[D].沈阳:中国医科大学,2009.
[15]MAHONEY F J,BARTHEL D W.Functional evaluation:the Barthel index[J].Md State Med J,1965,14:61-65.
[16]侯东哲,张颖,巫嘉陵,等.中文版Barthel指数的信度与效度研究[J].临床荟萃,2012,27(3):219-221.HOU D Z,ZHANG Y,WU J L,et al.Study on reliability and validity of Chinese version of Barthel index[J].Clinical Focus,2012,27(3):219-221.
[17]陈茜,邓秀琳,胡秀英.不同等级医院老年住院患者病区内环境安全评价[J].中国卫生事业管理,2016,33(5):343-345,370.CHEN Q,DENG X L,HU X Y.The hospital ward environment safety evaluation among the different levels hospitalized elderly patients[J].Chinese Health Service Management,2016,33(5):343-345,370.
[18]WARE J J,KOSINSKI M,KELLER S D.A 12-item ShortForm Health Survey:construction of scales and preliminary tests of reliability and validity[J].Med Care,1996,34(3):220-233.DOI:10.1097/00005650-199603000-00003.
[19]王红雨,张林.简版生活质量量表(SF-12)在农村高龄老年人中的测量信度与效度[J].上海交通大学学报(医学版),2016,36(7):1070-1074.DOI:10.3969/j.issn.1674-8115.2016.07.022.WANG H Y,ZHANG L.Reliability and validity of short form Quality Life Scale(SF-12)for elderly persons in countryside[J].Journal of Shanghai Jiao Tong University(Medical Science),2016,36(7):1070-1074.DOI:10.3969/j.issn.1674-8115.2016.07.022.
[20]FREDERICKKKA C,KEE-LEE C.Characteristics associated with fear of falling in Hong Kong Chinese elderly residing in care and attention homes[J].Clinical Gerontologist,2006,29(3):83-98.DOI:10.1300/J018v29n03_07.
[21]胡梦梦.居家长期照护失能老人跌倒危险因素及干预研究[D].北京:解放军医学院,2014.
[22]TAVSANLI N G,TURKMEN S N.Fear of falling in elderly people living in a nursing home-perspective from Manisa[J].J Pak Med Assoc,2015,65(4):418-420.
[23]LACHMAN M E,HOWLAND J.Fear of falling and activity restriction:the survey of activities and fear of falling in the elderly(SAFE)[J].Journals of Gerontology,1998,53(1):43.DOI:10.1093/geronb/53B.1.P43.2018122920190521
[2]LACH H W,PARSONS J L.Impact of fear of falling in long term care:an integrative review[J].Journal of the American Medical Directors Association,2013,14(8):573-577.DOI:10.1016/j.jamda.2013.02.019.
[3]管细红,朱晓钢,刘建民.瑜伽运动对早期帕金森病人平衡能力及害怕跌倒的影响[J].护理研究,2017,31(10):1274-1276.DOI:10.3969/j.issn.1009-6493.2017.10.040.GUAN X H,ZHU X G,LIU J M.Influence of Yoga on balancing ability and fear of falling in patients with early Parkinson's disease[J].Chinese Nursing Research,2017,31(10):1274-1276.DOI:10.3969/j.issn.1009-6493.2017.10.040.
[4]李博,钟清玲,余红,等.太极拳训练对帕金森患者平衡功能及害怕跌倒的影响[J].中国康复医学杂志,2017,32(3):309-312.DOI:10.3969/j.issn.1001-1242.2017.03.013.LI B,ZHONG Q L,YU H,et al.Influence of Taiji exercise on balance ability and fear of falling of patients with Parkinson's disease[J].Chinese Journal of Rehabilitation Medicine,2017,32(3):309-312.DOI:10.3969/j.issn.1001-1242.2017.03.013.
[5]CHL C L,LIANG C K,CHOW P C,et al.Fear of falling(FF):psychosocial and physical factors among institutionalized older Chinese men in Taiwan[J].Arch Gerontol Geriatr,2011,53(2):e232-236.DOI:10.1016/j.archger.2010.12.018.
[6]周白瑜,石婧,于普林.北京市社区老年人跌倒情况及其后果的相关因素研究[J].中华流行病学杂志,2013,34(8):778-781.DOI:10.3760/cma.j.issn.0254-6450.2013.08.006.ZHOU B Y,SHI J,YU P L.Consequence and risk factors of fallsrelated injuries in community-dwelling elderly in Beijing[J].Chin J Epidemiol,2013,34(8):778-781.DOI:10.3760/cma.j.issn.0254-6450.2013.08.006.
[7]KOCIC M,STOJANOVIC Z,LAZOVI M,et al.Relationship between fear of falling and functional status in nursing home residents aged older than 65 years[J].Geriatr Gerontol Int,2017,17(10):1470-1476.DOI:10.1111/ggi.12897.
[8]陈瑜,姜小鹰,杨美丽,等.养老机构老人跌倒效能状况及其影响因素分析[J].中国实用护理杂志,2016,32(6):412-415.DOI:10.3760/cma.j.issn.1672-7088.2016.06.004.CHEN Y,JIANG X Y,YANG M L,et al.Investigation on the fall efficacy of elderly people in nursing homes and its influencing factors[J].Chin J Prac Nurs,2016,32(6):412-415.DOI:10.3760/cma.j.issn.1672-7088.2016.06.004.
[9]张栋.北京市老年人机构养老意愿及影响因素研究[J].调研世界,2017,30(10):23-29.DOI:10.13778/j.cnki.11-3705/c.2017.10.004.ZHANG D.Study on the willingness and influence factors of elderly people in nursing homes in Beijing[J].The World of Survey and Research,2017,30(10):23-29.DOI:10.13778/j.cnki.11-3705/c.2017.10.004.
[10]许贤豪.神经心理量表检测指南[M].北京:中国协和医科大学出版社,2007:17.
[11]中华人民共和国民政部.中华人民共和国民政行业标准MZ/T 039-2013老年人能力评估[S/OL].[2019-01-05].http://images3.mca.gov.cn/www/file/201703/1490939975354.pdf.
[12]TINETTI M E,RICHMAN D,POWELL L.Falls efficacy as a measure of fear of falling[J].J Gerontol,1990,45(6):239-243.DOI:10.1093/geronj/45.6.p239.
[13]HILL K D,SCHWARZ J A,KALOGEROPOULOS A J,et al.Fear of falling revisited[J].Arch Phys Med Rehabil,1996,77(10):1025-1029.DOI:10.1016/s0003-9993(96)90063-5.
[14]包月.老年公寓老人害怕跌倒心理及影响因素的研究[D].沈阳:中国医科大学,2009.
[15]MAHONEY F J,BARTHEL D W.Functional evaluation:the Barthel index[J].Md State Med J,1965,14:61-65.
[16]侯东哲,张颖,巫嘉陵,等.中文版Barthel指数的信度与效度研究[J].临床荟萃,2012,27(3):219-221.HOU D Z,ZHANG Y,WU J L,et al.Study on reliability and validity of Chinese version of Barthel index[J].Clinical Focus,2012,27(3):219-221.
[17]陈茜,邓秀琳,胡秀英.不同等级医院老年住院患者病区内环境安全评价[J].中国卫生事业管理,2016,33(5):343-345,370.CHEN Q,DENG X L,HU X Y.The hospital ward environment safety evaluation among the different levels hospitalized elderly patients[J].Chinese Health Service Management,2016,33(5):343-345,370.
[18]WARE J J,KOSINSKI M,KELLER S D.A 12-item ShortForm Health Survey:construction of scales and preliminary tests of reliability and validity[J].Med Care,1996,34(3):220-233.DOI:10.1097/00005650-199603000-00003.
[19]王红雨,张林.简版生活质量量表(SF-12)在农村高龄老年人中的测量信度与效度[J].上海交通大学学报(医学版),2016,36(7):1070-1074.DOI:10.3969/j.issn.1674-8115.2016.07.022.WANG H Y,ZHANG L.Reliability and validity of short form Quality Life Scale(SF-12)for elderly persons in countryside[J].Journal of Shanghai Jiao Tong University(Medical Science),2016,36(7):1070-1074.DOI:10.3969/j.issn.1674-8115.2016.07.022.
[20]FREDERICKKKA C,KEE-LEE C.Characteristics associated with fear of falling in Hong Kong Chinese elderly residing in care and attention homes[J].Clinical Gerontologist,2006,29(3):83-98.DOI:10.1300/J018v29n03_07.
[21]胡梦梦.居家长期照护失能老人跌倒危险因素及干预研究[D].北京:解放军医学院,2014.
[22]TAVSANLI N G,TURKMEN S N.Fear of falling in elderly people living in a nursing home-perspective from Manisa[J].J Pak Med Assoc,2015,65(4):418-420.
[23]LACHMAN M E,HOWLAND J.Fear of falling and activity restriction:the survey of activities and fear of falling in the elderly(SAFE)[J].Journals of Gerontology,1998,53(1):43.DOI:10.1093/geronb/53B.1.P43.2018122920190521
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