社区老年人害怕跌倒心理与ADL能力及抑郁相关性的研究
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摘要
目的:通过对社区老年人害怕跌倒心理和身体机能的现状调查,了解老年人害怕跌倒的影响因素,明确害怕跌倒的心理对老年人ADL的影响,探讨害怕跌倒心理与身体机能、抑郁之间的关系,以增强老年人对害怕跌倒心理的正确认识,采取有效的措施预防和减少害怕跌倒心理对老年人生活和健康的影响。
方法:本次调查以石家庄市长安区的社区老年人为调查对象,调查的内容包括:自行编制的一般情况调查表(人口学特征、跌倒史、生活状态、健康状况)、跌倒功效量表(中文版)、改良Bathel指数评定量表、老年抑郁量表及Berg平衡量表。运用统计描述与分析,多元逐步回归分析及Spearman相关性分析的方法,对老年人害怕跌倒心理现状及其影响因素以及与ADL能力和抑郁的关系进行分析。
结果:本次调查共获得有效问卷304份,其中男性101例,女性203例,年龄范围为60～92岁。文化程度总体较低,没有害怕跌倒者为133例,23%的参与者生活状态是独居。分析结果显示:
1研究对象跌倒功效量表得分的中位数为8.82分,其中“更衣”、“准备简单的饭菜”、“在房间里走动”的中位数为10分,“从椅子上起落”、“上床与下床”、“应门或接电话”、“伸手到箱子或抽屉里拿东西”、“做轻体力家务活”、“简单购物”、“做轻体力园艺或晾晒衣服”的中位数为9分,“沐浴”、“乘坐公共交通工具”、“过马路”、“上下楼梯”的中位数是8分。
2调查对象害怕跌倒的单因素分析
老年人年龄与跌倒功效量表得分呈显著负相关(P<0.01),说明老年人年龄越大,跌倒功效量表的得分越低,害怕跌倒的程度越高;老年人的慢性疾病数与跌倒功效量表得分亦呈显著负相关(P<0.01),说明老年人的疾病数越多,跌倒功效量表的得分越低,老年人害怕跌倒的程度越高。
不同工作性质的老年人,害怕跌倒的程度有显著性差异(P<0.05),体力劳动者的害怕跌倒程度比非体力劳动者高。不同受教育程度老年人害怕跌倒之间的差异有显著统计学意义(P<0.01)。学历层次越高,跌倒功效量表的得分越高,害怕跌倒的程度越小。活动锻炼情况不同的老年人,害怕跌倒的程度有显著性差异(P<0.01),经常活动锻炼的老年人跌倒功效量表的得分最高,而从不活动锻炼的老年人,其害怕跌倒的心理最强烈。有无跌倒史的老年人害怕跌倒之间的差异有显著统计学意义(P<0.01),有过跌倒经历老年人的害怕跌倒程度大于没有跌倒经历的老年人。跌倒后受伤情况不同的老年人害怕跌倒的程度有显著性差异(P<0.01),有受伤者的害怕程度大于没有受伤者。是否使用辅助器具的老年人害怕跌倒的程度有显著性差异(P<0.01),使用辅助器具的老年人比不使用辅助器具老年人的害怕跌倒程度高。
3调查对象害怕跌倒的多因素分析
多元逐步回归结果显示,影响老年人害怕跌倒的因素按照影响作用由大到小依次是:辅助器具使用、活动锻炼情况、年龄、慢性疾病数,对老年人害怕跌倒变异的解释度为35.0%。结果提示,使用辅助器具的老年人较不使用辅助器具的老人害怕跌倒的程度高;活动锻炼的次数越多,害怕跌倒的程度越低;年龄越大,害怕跌倒的程度越高;慢性疾病数越多,老年人害怕跌倒的程度越高。
4调查对象害怕跌倒与ADL能力、平衡能力及抑郁的相关性
老年人害怕跌倒心理与其ADL能力呈负相关(P<0.01),即老年人的日常生活活动能力越高,跌倒功效量表的得分越高,害怕跌倒的心理越小。老年人害怕跌倒心理与其平衡能力呈负相关(P<0.01),即老年人的平衡能力越好,跌倒功效量表的得分越高,害怕跌倒的心理越小。老年人害怕跌倒与抑郁呈正相关(P<0.01),即老年人的抑郁程度越高,跌倒功效量表的得分越低,害怕跌倒的心理越大。
结论:社区老年人害怕跌倒的功效量表得分为8.82分。辅助器具使用、活动锻炼情况、年龄、慢性疾病数四个因素是社区老年人害怕跌倒的影响因素,对老年人害怕跌倒的变异解释度为35.0%,老年人的害怕跌倒心理与ADL能力和平衡能力呈负相关,与抑郁情绪呈正相关。建议今后的研究可在此基础上扩大影响因素范围,增加样本量,进一步探讨对可干预因素措施的研究。
Objective: The aims of this study were to determine the status of physical function and fear of falling among the older persons living community.To explore the influencing factors of fear of falling. Its aim was to identify the impact factors on activities of daily living because of fear of falling. To investigate the correlation of fear of falling, physical function and depression. It would improve the right views on fear of falling in older persons and take effective measures to prevent and reduce the influencing on living and health of older persons with fear of falling .
Methods: The ChangAn community living older persons of Shijiazhuang were investigated by questionnaires. The contents of questionnaire included features of population, the falls history, living status, health status, the Modified Falls Efficacy Scales, the Modified Barthel Index, the Short Geriatric Depression Scale, and physical performance measures (Berg Balance Scale).Descriptive Statistics-Frequencies, Crosstabs, Nonparametric test, Multiple stepwise regression, Spearman Correlation were performed to study the states and the impact factors.
Results: A total of 304 valid questionnaires were obtained. The age ranged from 60 to 92. 203 participants were female, 101 participants were male. The majority education were lower.133 participants reported no fear of falling, And 23% participants reported that they have lived alone. The results were followed:
1 The median of the Modified Falls Efficacy Scale was 8.82, the median of the three items on“Get dressed and undressed”,“Prepare a simple meal”,“Walk around the inside of your house”were 10; the median of the seven items on“Get in/out of a chair”,“Get in/out of bed”,“Answer the door or telephone”,“Reach into cabinets or closet”,“Light housekeeping”,“Simple shopping”, “Light gardening or hanging out the washing”were 9; the median of other items on“Take a bath or a shower”,“Using public transport”,“Crossing roads”,“Using front or rear steps at home”were 8.
2 Univariate analysis of the impact factors showed that the fear of falling status was negative correlation with aging(P<0.01),it indicated that older persons age was bigger, the score of Modified Falls Efficacy Scale was lower. And the fear of falling degree was higher. The fear of falling status was negative correlation with chronic medical conditions(P<0.01), it explained that chronic medical conditions of older persons was more serious, the degree of fear falling was higher.
A significant difference was identified on the terms of pre-retirement career. The degree of fear of falling in manual workers were significantly higher than the non-manual workers. There were significant differences in terms of educational level(P<0.05).The longer was educational time of older persons, the higher was the Modified Falls Efficacy Scale score and lower. There had significant differences in terms of physical activity. The olders joining excise usually had the highest score in the Modified Falls Efficacy Scale. It showed that the participants of the group had a lower fear; conversely, the persons never joining excise had the strongest fear of falling. Meanwile, there were significant differences between the group of a history and not.The level of fear in participants with a history of fall were higher than without history of fall. There were significant differences in terms of a history of an injurious fall, the persons had a history of an injurious fall were higher fear. There were significant differences between the groups of using a gait aids and not, using gait aids the stronger fear.
3 Based on the study results of multiple regression analysis, the influential factors of fear of falling were using a gait aids, participate in a physical activity program, aging, chronic medical conditions explained 35.0% of the variance of the fear of falling.
4 The correlation among fear of falling , ADL, balance and depression The fear of falling was significantly negative correlation to ADL(P< 0.01); the fear of falling was significantly negative correlation to their balance(P<0.01); and the fear of falling was significantly positive correlation to depression(P<0.01).
Conclusion: The median of the Modified Falls Efficacy Scale was 8.82. Using a gait aids, participate in a physical activity program, aging, chronic medical conditions explained 35.0% of the variance of the fear of falling. Fear of falling status was negatively related to ADL and balance, and positively corrected to depression. Therefore, further study is necessary to increase the example and to explore the influential factors of management more deeply.
方法:本次调查以石家庄市长安区的社区老年人为调查对象,调查的内容包括:自行编制的一般情况调查表(人口学特征、跌倒史、生活状态、健康状况)、跌倒功效量表(中文版)、改良Bathel指数评定量表、老年抑郁量表及Berg平衡量表。运用统计描述与分析,多元逐步回归分析及Spearman相关性分析的方法,对老年人害怕跌倒心理现状及其影响因素以及与ADL能力和抑郁的关系进行分析。
结果:本次调查共获得有效问卷304份,其中男性101例,女性203例,年龄范围为60～92岁。文化程度总体较低,没有害怕跌倒者为133例,23%的参与者生活状态是独居。分析结果显示:
1研究对象跌倒功效量表得分的中位数为8.82分,其中“更衣”、“准备简单的饭菜”、“在房间里走动”的中位数为10分,“从椅子上起落”、“上床与下床”、“应门或接电话”、“伸手到箱子或抽屉里拿东西”、“做轻体力家务活”、“简单购物”、“做轻体力园艺或晾晒衣服”的中位数为9分,“沐浴”、“乘坐公共交通工具”、“过马路”、“上下楼梯”的中位数是8分。
2调查对象害怕跌倒的单因素分析
老年人年龄与跌倒功效量表得分呈显著负相关(P<0.01),说明老年人年龄越大,跌倒功效量表的得分越低,害怕跌倒的程度越高;老年人的慢性疾病数与跌倒功效量表得分亦呈显著负相关(P<0.01),说明老年人的疾病数越多,跌倒功效量表的得分越低,老年人害怕跌倒的程度越高。
不同工作性质的老年人,害怕跌倒的程度有显著性差异(P<0.05),体力劳动者的害怕跌倒程度比非体力劳动者高。不同受教育程度老年人害怕跌倒之间的差异有显著统计学意义(P<0.01)。学历层次越高,跌倒功效量表的得分越高,害怕跌倒的程度越小。活动锻炼情况不同的老年人,害怕跌倒的程度有显著性差异(P<0.01),经常活动锻炼的老年人跌倒功效量表的得分最高,而从不活动锻炼的老年人,其害怕跌倒的心理最强烈。有无跌倒史的老年人害怕跌倒之间的差异有显著统计学意义(P<0.01),有过跌倒经历老年人的害怕跌倒程度大于没有跌倒经历的老年人。跌倒后受伤情况不同的老年人害怕跌倒的程度有显著性差异(P<0.01),有受伤者的害怕程度大于没有受伤者。是否使用辅助器具的老年人害怕跌倒的程度有显著性差异(P<0.01),使用辅助器具的老年人比不使用辅助器具老年人的害怕跌倒程度高。
3调查对象害怕跌倒的多因素分析
多元逐步回归结果显示,影响老年人害怕跌倒的因素按照影响作用由大到小依次是:辅助器具使用、活动锻炼情况、年龄、慢性疾病数,对老年人害怕跌倒变异的解释度为35.0%。结果提示,使用辅助器具的老年人较不使用辅助器具的老人害怕跌倒的程度高;活动锻炼的次数越多,害怕跌倒的程度越低;年龄越大,害怕跌倒的程度越高;慢性疾病数越多,老年人害怕跌倒的程度越高。
4调查对象害怕跌倒与ADL能力、平衡能力及抑郁的相关性
老年人害怕跌倒心理与其ADL能力呈负相关(P<0.01),即老年人的日常生活活动能力越高,跌倒功效量表的得分越高,害怕跌倒的心理越小。老年人害怕跌倒心理与其平衡能力呈负相关(P<0.01),即老年人的平衡能力越好,跌倒功效量表的得分越高,害怕跌倒的心理越小。老年人害怕跌倒与抑郁呈正相关(P<0.01),即老年人的抑郁程度越高,跌倒功效量表的得分越低,害怕跌倒的心理越大。
结论:社区老年人害怕跌倒的功效量表得分为8.82分。辅助器具使用、活动锻炼情况、年龄、慢性疾病数四个因素是社区老年人害怕跌倒的影响因素,对老年人害怕跌倒的变异解释度为35.0%,老年人的害怕跌倒心理与ADL能力和平衡能力呈负相关,与抑郁情绪呈正相关。建议今后的研究可在此基础上扩大影响因素范围,增加样本量,进一步探讨对可干预因素措施的研究。
Objective: The aims of this study were to determine the status of physical function and fear of falling among the older persons living community.To explore the influencing factors of fear of falling. Its aim was to identify the impact factors on activities of daily living because of fear of falling. To investigate the correlation of fear of falling, physical function and depression. It would improve the right views on fear of falling in older persons and take effective measures to prevent and reduce the influencing on living and health of older persons with fear of falling .
Methods: The ChangAn community living older persons of Shijiazhuang were investigated by questionnaires. The contents of questionnaire included features of population, the falls history, living status, health status, the Modified Falls Efficacy Scales, the Modified Barthel Index, the Short Geriatric Depression Scale, and physical performance measures (Berg Balance Scale).Descriptive Statistics-Frequencies, Crosstabs, Nonparametric test, Multiple stepwise regression, Spearman Correlation were performed to study the states and the impact factors.
Results: A total of 304 valid questionnaires were obtained. The age ranged from 60 to 92. 203 participants were female, 101 participants were male. The majority education were lower.133 participants reported no fear of falling, And 23% participants reported that they have lived alone. The results were followed:
1 The median of the Modified Falls Efficacy Scale was 8.82, the median of the three items on“Get dressed and undressed”,“Prepare a simple meal”,“Walk around the inside of your house”were 10; the median of the seven items on“Get in/out of a chair”,“Get in/out of bed”,“Answer the door or telephone”,“Reach into cabinets or closet”,“Light housekeeping”,“Simple shopping”, “Light gardening or hanging out the washing”were 9; the median of other items on“Take a bath or a shower”,“Using public transport”,“Crossing roads”,“Using front or rear steps at home”were 8.
2 Univariate analysis of the impact factors showed that the fear of falling status was negative correlation with aging(P<0.01),it indicated that older persons age was bigger, the score of Modified Falls Efficacy Scale was lower. And the fear of falling degree was higher. The fear of falling status was negative correlation with chronic medical conditions(P<0.01), it explained that chronic medical conditions of older persons was more serious, the degree of fear falling was higher.
A significant difference was identified on the terms of pre-retirement career. The degree of fear of falling in manual workers were significantly higher than the non-manual workers. There were significant differences in terms of educational level(P<0.05).The longer was educational time of older persons, the higher was the Modified Falls Efficacy Scale score and lower. There had significant differences in terms of physical activity. The olders joining excise usually had the highest score in the Modified Falls Efficacy Scale. It showed that the participants of the group had a lower fear; conversely, the persons never joining excise had the strongest fear of falling. Meanwile, there were significant differences between the group of a history and not.The level of fear in participants with a history of fall were higher than without history of fall. There were significant differences in terms of a history of an injurious fall, the persons had a history of an injurious fall were higher fear. There were significant differences between the groups of using a gait aids and not, using gait aids the stronger fear.
3 Based on the study results of multiple regression analysis, the influential factors of fear of falling were using a gait aids, participate in a physical activity program, aging, chronic medical conditions explained 35.0% of the variance of the fear of falling.
4 The correlation among fear of falling , ADL, balance and depression The fear of falling was significantly negative correlation to ADL(P< 0.01); the fear of falling was significantly negative correlation to their balance(P<0.01); and the fear of falling was significantly positive correlation to depression(P<0.01).
Conclusion: The median of the Modified Falls Efficacy Scale was 8.82. Using a gait aids, participate in a physical activity program, aging, chronic medical conditions explained 35.0% of the variance of the fear of falling. Fear of falling status was negatively related to ADL and balance, and positively corrected to depression. Therefore, further study is necessary to increase the example and to explore the influential factors of management more deeply.
引文
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4 Tinetti M, Richman D, Powell L. Falls efficacy as a measure of fear of falling. Gerontol Psych Sci, 1990, 45:239-243
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1北京协和医院世界卫生组织疾病分类合作中心编译.疾病和有关健康问题的国际统计分类ICD--IO.第10版.北京:人民卫生出版社,1996,839–841
2 Stel VS,Smit JH,Pluijm SM,et al. Consequences of falling in older men and women and risk factors for health service use and functional decline. Age Ageing, 2004,33(1):58-65
3 Luukinen H, Koski K S-L Kivela, Laippala P. Social status, life changes, housing conditions, health, functional abilities and life-style as risk factors for recurrent falls among the home-dwelling elder. The Society of Public Health, 1996,110:115-118
4 Tinetti M, Richman D, Powell L. Falls efficacy as a measure of fear of falling. Gerontol Psych Sci, 1990,45:239-243
5 Suzanne M,Gillespie MD,Susan,M, et al. Fear of falling in New Long-term Care Enrollees.AMDA,2007,6:307-313
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8 Yardley L, Smith H. A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist, 2002, 42:17-23
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12 Andresen E M, Wolinsky F D, Miller J P, et al. Cross-sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle aged African Americans. Gerontologist 2006,46:249–257.
13 Thomas AA, Rogers JM, Amick MM, et al. Falls and the falls efficacy scale in Parkinson's disease. Neurol, 2010, 2: 16
14 Perez-Jara J, Enguix A, Fernandez-Quintas JM, et al. Fear of falling among elderly patients with dizziness and syncope in a tilt setting. Can J Aging, 2009,28,(2):157-163
15 Sharaf AY, Ibrahim HS. Physical and psychosocial correlates of fear of falling: among older adults in assisted living facilities. Gerontol Nurs, 2008,34,(12):27-35
16 Nitz JC, Choy NL. The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomized controlled trial. Age and Ageing, 2004, 33:52–58.
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21 Zijlstra GA, Van Haastregt JC, Ambergen T, et al. Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. J Am Geriatr Soc, 2009, 12, 57(11):2020-2028
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4 Tinetti M, Richman D, Powell L. Falls efficacy as a measure of fear of falling. Gerontol Psych Sci, 1990,45:239-243
5 Suzanne M,Gillespie MD,Susan,M, et al. Fear of falling in New Long-term Care Enrollees.AMDA,2007,6:307-313
6 Mizue Suzuki, Naomi Ohyama, Kiyomi Yamada,et al, The relationship between fear of falling, activities of daily living and quality of life among elderly individuals. Nursing and Health Sciences, 2002,4:155-16
7 Dukyoo Jung. Fear of falling in older adults: comprehensive review. Asian Nursing Research, 2008, 2, (4):214-222
8 Yardley L, Smith H. A prospective study of the relationship between feared consequences of falling and avoidance of activity in community-living older people. Gerontologist, 2002, 42:17-23
9 Kempen G, Zijlstra J, van Haastregt. Fear of falling in old age. Risk factors, consequences and intervention. Parkinsonism & Related Disorders, 2008, 14, PL4.1 : S
10 Nadine Gagnon, Alastair J, Flint Gary Naglie, et al. Affective correlates of fear of falling in elderly persons. Am J. Geriatr,2005,13:1
11 Hellstr?m K, Vahlberg B, Urell C,et al. Fear of falling, fall-related self-efficacy, anxiety and depression in individuals with chronic obstructive pulmonary disease. Clin Rehabil ,2009, 23, (12):1136
12 Andresen E M, Wolinsky F D, Miller J P, et al. Cross-sectional and longitudinal risk factors for falls, fear of falling, and falls efficacy in a cohort of middle aged African Americans. Gerontologist 2006,46:249–257.
13 Thomas AA, Rogers JM, Amick MM, et al. Falls and the falls efficacy scale in Parkinson's disease. Neurol, 2010, 2: 16
14 Perez-Jara J, Enguix A, Fernandez-Quintas JM, et al. Fear of falling among elderly patients with dizziness and syncope in a tilt setting. Can J Aging, 2009,28,(2):157-163
15 Sharaf AY, Ibrahim HS. Physical and psychosocial correlates of fear of falling: among older adults in assisted living facilities. Gerontol Nurs, 2008,34,(12):27-35
16 Nitz JC, Choy NL. The efficacy of a specific balance-strategy training programme for preventing falls among older people: A pilot randomized controlled trial. Age and Ageing, 2004, 33:52–58.
17 Filiatrault J, Desrosiers J, Trottier L. An exploratory study of individual and environmental correlates of fear of falling among community-dwelling seniors. Aging Health, 2009,21,(6):881-894
18 Kempen GI, van Haastregt JC, McKee KJ,et al. Socio-demographic, health-related and psychosocial correlates of fear of falling and avoidance of activity in community-living older persons who avoid activity due to fear of falling. BMC Public Health, 2009, 2, (9):170
19 Margaret K, Mak Anna L. Validation of the Chinese Translated Activities-Specific Balance Confidence Scale.Arch Phys Med Rehabil , 2007, 4:496-503
20 Denkinger MD, Igl W, Lukas A, et al. Relationship between fear of falling and outcomes of an inpatient geriatric rehabilitation population--fear of the fear of falling. J Am Geriatr Soc. 2010, 58,(4):664-673
21 Zijlstra GA, Van Haastregt JC, Ambergen T, et al. Effects of a multicomponent cognitive behavioral group intervention on fear of falling and activity avoidance in community-dwelling older adults: results of a randomized controlled trial. J Am Geriatr Soc, 2009, 12, 57(11):2020-2028
22 Gomez F, Curcio CL, The development of a fear of falling interdisciplinary intervention program. Clin Interv Aging, 2007,2,(4):661-667
23 Schmid AA, Van Puymbroeck M, Koceja DM. Effect of a 12-week yoga intervention on fear of falling and balance in older adults: a pilot study.Arch Phys Med Rehabil, 2010, 91,(4):576-83
24 Cakit BD, Saracoglu M, Genc H, et al. The effects of incremental speed-dependent treadmill training on postural instability and fear of falling in Parkinson's disease. Clin Rehabil, 2007,21(8):698-705
25 Dukyoo Jung, Juhee Lee, Lee SM. A meta-analysis of fear of falling treatment programs for the elderly.West J Nurs Res, 2009, 3, 31(1:6-16)