摘要
目的对北京市、上海市、青岛市、成都市的社区老年人跌倒流行情况进行调查,并探讨影响社区老年人跌倒的危险因素,为开展预防老年人跌倒的相关工作提供理论依据。方法采取多阶段随机抽样的方法从北京市、上海市、青岛市、成都市的社区内共抽取60岁及以上老年人共2 060人,用修订版社区老年人跌倒危险评估工具(Modified Falls Risk for Older People in the Community screening tool,MFROP-Com)进行调查;应用■检验和logistic回归分析可能影响老年人跌倒发生的因素。结果调查对象最近一年跌倒率为19.2%,重复跌倒率为7.4%。logistic回归结果显示:与60～69岁组相比,70～79岁(OR=1.211,P=0.041)、80～89岁(OR=1.573,P=0.001)、≥90岁(OR=1.752,P=0.022)3个年龄段老年人更易发生跌倒;同与老伴同住者相比,与子女居住(OR=1.511,P=0.039)、独居(OR=2.752,P=0.017)的老年人更易跌倒;患1～2种(OR=1.435,P<0.001)、≥3种(OR=1.609,P<0.001)疾病的老年人比未患病者更易跌倒;同步行平稳的老年人相比,步态轻度不稳(OR=1.374,P=0.031)、中度不稳(OR=1.821,P=0.001)、重度不稳(OR=2.932,P<0.001)者更易跌倒;有认知障碍(轻度OR=2.861、P=0.029,中度OR=1.735、P=0.007,重度OR=1.283、P=0.005)的老年人比认知正常的老年人更易发生跌倒;与总是知道自己能力的老年人相比,低估自己能力(OR=1.165,P=0.014)、知道但总做超出能力范围的事(OR=1.821,P=0.026)、高估自己能力(OR=2.872,P=0.046)者更易发生跌倒;除此之外,女性(OR=1.574,P=0.021)、无配偶(OR=1.963,P<0.001)、视力下降(OR=1.403,P=0.043)也是老年人跌倒的危险因素。结论北京市、上海市、青岛市、成都市的社区老年人跌倒率较高,跌倒后造成的损伤不容乐观,且受多种因素共同影响,应采取综合措施进行防范。
Objective To know the prevalence of fall among community elderly from four cities in China including Beijing,Shanghai,Qingdao and Chengdu,to explore the risk factors of fall of community elderly,and to provide a theoretical basis for fall prevention.Methods Multi-stage random sampling method was used to select 2 060 community elderly aged 60 years old and from Beijing,Shanghai,Qingdao,Chengdu.Modified Falls Risk for Older People in the Community screening tool(MFROP-Com)was used in the survey. 2 test and logistic regression were used for data analysis to explore risk factors of fall in the elderly.Results The incidence of fall in respondents was 19.2%,and 7.4% of older adults fell at least twice in the last year.The result of logistic regression indicated that compared people with aged 60～69,people aged 70～79(OR=1.211,P=0.041),80～89(OR=1.573,P=0.001)and ≥90(OR=1.752,P=0.022)were more likely to fall.Compared to the elderly living with a partner,the elderly who lived with children(OR=1.511,P=0.039)and solitary(OR=2.752,P=0.017)were more likely to fall.Compared to healthy people,people with one or two diseases(OR=1.435,P<0.001)and above three diseases(OR=1.609,P<0.001)were more likely to fall.Compared with the elderly walking steadily,unstable(mild:OR=1.374,P=0.031;moderate:OR=1.821,P=0.001;severe:OR=2.932,P<0.001)old people were more likely to fall.The elderly with cognition impairment(mild:OR=2.861,P=0.029;moderate:OR=1.735,P=0.007;severe:OR=1.283,P=0.005)were more likely to fall than normal elderly.And people who underestimated own ability(OR=1.165,P=0.014),knew but always over own ability(OR=1.821,P=0.026),overestimated own ability(OR=2.872,P=0.046)were more likely to fall than the elder always knew own ability.In addition,female(OR=1.574,P=0.021),single(OR=1.963,P<0.001)and visual loss(OR=1.403,P=0.043)were risk factors of fall among community elderly.Conclusion The incidence of fall in community-dwelling older adults from Beijing,Shanghai,Qingdao,and Chengdu is high,and the injury of falls is not optimistic.The fall of older adults in China is affected by a variety of factors.To prevent falls,comprehensive measures should be taken.
引文
[1] Oliver D,Britton M,Seed P,et al.Development and evaluation of evidence based risk assessment tool(STRATIFY)to predict which elder living patients will fall:case-control and cohort studies[J].The British Medical Journal,1997,315(7115):1049-1053.
[2] 国家卫生和计划生育委员会统计信息中心.中国死因监测数据集2015[M].北京:中国科学技术出版社,2016:62.
[3] 王利维,周立.修订版社区老年人跌倒危险评估工具在我国应用的信效度研究[J].护理学报,2011,18(17):12-15.
[4] 王晨.北京市西城区社区老年人跌倒现况及危险因素调查[J].职业与健康,2015,31(1):52-54.
[5] Niino N,Kozakai R,Eto M.Epidemiology of falls community-dwelling elderly people[J].Japanese Journal of Geriatrics,2003,40(5):484-486.
[6] 姜玉,夏庆华.老年跌倒相关平衡能力测试研究[J].现代预防医学,2011,38(4):672-674.
[7] Karlsson MK,Magnusson H,Von Schewelov T,et al.Prevention of falls in the elderly-a review[J].Osteoporosis International,2013,24(3):747-762.
[8] Faber MJ,Bosscher RJ,Chin AP,et al.Effects of exercise programs on falls and mobility in frail and pre-frail older adults:a multicenter randomized controlled trail[J].Archives Physical Medicine and Rehabilitation,2006,87:885-896.
[9] 刘向红.婚姻状况、居住方式对老年健康的影响研究[D].保定:河北大学,2006.
[10] Hu J,Xia QH,Jiang Y,et al.Risk factors of indoor fall injuries in community-dwelling older women:a prospective cohort study[J].Archives of Gerontology and Geriatrics,2015,60(2):259-264.
[11] 张福金,燕铁斌.老年跌倒问题[J].国外医学(物理医学与康复学分册),2002,22(4):163-164,167.
