社区与住院老年人跌倒的现状及影响因素

doi:10.3969/j.issn.1006-9771.2022.04.004

《中国康复理论与实践》 ›› 2022, Vol. 28 ›› Issue (4): 389-398.doi: 10.3969/j.issn.1006-9771.2022.04.004

• 专题肌力对姿势稳定影响的研究 • 上一篇下一篇

社区与住院老年人跌倒的现状及影响因素

刘晓燕^1a,丁霞²,董晨^1b,李荣³,孙驰^1a()

1.南通大学附属医院,a.老年医学科;b.临床医学中心,江苏南通市 226001
2.南通大学附属医院医联体天生港社区卫生服务中心,江苏南通市 226001
3.南通大学护理学院,江苏南通市 226001

收稿日期:2021-12-06 修回日期:2022-03-29 出版日期:2022-04-25 发布日期:2022-05-05
通讯作者: 孙驰 E-mail:tdfy_sc@126.com
作者简介:刘晓燕(1989-),女,汉族,江苏南通市人,硕士研究生,主管护师,主要研究方向：老年护理。
基金资助:
南通市科技指导项目(MSZ20019)

Status and related factors of fall among the elderly in community and hospital

LIU Xiaoyan^1a,DING Xia²,DONG Chen^1b,LI Rong³,SUN Chi^1a()

1. a.Department of Geriatrics; b.Clinical Medical Research Center, Affiliated Hospital of Nantong University, Nantong, Jiangsu 226001, China
2. Affiliated Hospital of Nantong University Medical Union Tiansheng Gang Community Health Service Center, Nantong, Jiangsu 226001, China
3. Nursing School, Nantong University, Nantong, Jiangsu 226001, China

Received:2021-12-06 Revised:2022-03-29 Published:2022-04-25 Online:2022-05-05
Contact: SUN Chi E-mail:tdfy_sc@126.com
Supported by:
Nantong Science and Technology Guidance Project(MSZ20019)

摘要/Abstract

摘要：

目的分析社区和住院老年人跌倒的影响因素。方法 2021年5月至9月,采用随机系统抽样方法在南通大学附属医院医联体天生港社区卫生服务中心抽取50例社区老年人,在老年医学科抽取50例住院老年人,分别进行面对面问卷调查,并进行老年综合评估和血液、神经肌骨B超测试。采用单变量和多变量Logistic回归分析1年内有跌倒史的社区和住院老年人的跌倒现状及影响因素情况。结果住院与社区老年人在跌倒史、Morse跌倒风险评估量表(MFS)评分、因跌倒史住院方面均有显著性差异(χ² > 6.250, Z=-3.132, P<0.05)。除跌倒相关因素外,年龄、生活自理能力、国际尿失禁咨询委员会尿失禁问卷表简表(ICI-Q-SF)评分、衰弱指数(FI)、身体活动快速评估(RAPA)部分2评分、健康调查简表(SF-36)评分、纽芬兰纪念大学幸福度量表(MUNSH)评分、腰臀比、臂围、腿围、红细胞计数、红细胞压积、血红蛋白和甘油三酯均与住院老年人跌倒有关(|Z| > 0.462, χ²=7.447, P<0.05);老年抑郁量表(GDS)-15评分、MFS评分、FI、SF-36评分和握力均与社区老年人跌倒有关(|Z| > 1.758, χ²=6.640, P<0.05)。多因素Logistic回归分析结果显示,住院老年人1年内有跌倒史的跌倒影响因素有年龄、MFS评分、FI、臂围、腿围、SF-36评分、血红蛋白和甘油三酯(P<0.05);社区老年人的跌倒影响因素有GDS-15评分、MFS评分、FI、握力、SF-36评分和MUNSH评分(P<0.05)。此外,住院和社区老年人发生跌倒后SF-36评分和MUNSH评分均降低(t=-3.108, Z > 2.567, P<0.05)。结论住院老年人跌倒发生率、因跌倒住院率以及跌倒风险均较社区老年人高,影响因素各不相同。医护及社区、家庭成员应针对相应的影响因素进行干预,减少跌倒的发生。

关键词: 社区, 住院, 老年人, 跌倒, 影响因素

Abstract:

Objective To investigate the related factors of fall among community-dwelling and hospitalized elderly.Methods From May to September, 2021, 50 elderly from Tianshenggang Community Health Service Center of Medical Union of Nantong University Affiliated Hospital and 50 elderly in the first ward of Geriatrics Department of Nantong University Affiliated Hospital were selected by random systematic sampling method. Face-to-face questionnaire survey was conducted respectively. All the participants underwent a comprehensive geriatric assessment and blood, neuromusculoskeletal B-ultrasound tests. Univariate and multivariate Logistic regression were used to analyze the status and related factors of falls among community and hospitalized elderly with a history of falls within one year.Results There were significant differences in fall history, the score of Morse Fall Scale (MFS) and hospitalization due to fall history between the hospitalized elderly and the community-dwelling elderly (χ² > 6.250, Z=-3.132, P<0.05). In addition to fall related factors, age, ability of self-care, the score of International Consultation on Incontinence Questionnaire Urinary Incontinence Short Form (ICI-Q-SF), frailty index (FI), the score of Rapid Assessment of Physical Activity (RAPA) part 2, the score of Short Form of Health Survey (SF-36), the score of Memorial University of Newfoudland Scale of Happiness (MUNSH), waist-to-hip ratio, arm and leg circumferences, red blood cell count, hemoglobin and triglyceride were the related factors of fall in hospitalized elderly (|Z| > 0.462, χ²=7.447, P<0.05). The scores of Geriatric Depression Scale (GDS)-15, MFS, FI and SF-36, and grip strength were the related factors of fall in community-dwelling elderly (|Z| > 1.758, χ²=6.640, P<0.05). Multivariate Logistic regression analysis showed that the risk factors for falls in hospitalized elderly within one year were age, the score of MFS, FI, arm and leg circumferences, the score of SF-36, hemoglobin and triglyceride. The related factors of falls in community-dwelling elderly included the scores of GDS-15, MFS, FI SF-36 and MUNSH, and grip strength (P<0.05). The scores of SF-36 and MUNSH decreased after fall for elderly in both community and hospital (t=-3.108, Z > 2.567, P<0.05).Conclusion The incidence of falls and hospitalization due to falls, and the risk of falls are higher among the hospitalized elderly than that in community, and the related factors are different. Therefore, it is needed to carry out targeted intervention for the corresponding factors to reduce the occurrence of fall.

Key words: community, hospitalization, aged, fall, related factors

刘晓燕,丁霞,董晨,李荣,孙驰. 社区与住院老年人跌倒的现状及影响因素[J]. 《中国康复理论与实践》, 2022, 28(4): 389-398.

LIU Xiaoyan,DING Xia,DONG Chen,LI Rong,SUN Chi. Status and related factors of fall among the elderly in community and hospital[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2022, 28(4): 389-398.

图/表 7

表1

表2

表3

社区和住院老年人跌倒的综合评估比较"

变量	住院老年人(n=50)		社区老年人(n=50)		χ²/Z/t值^a	P值^a	χ²/Z/t值^b	P值^b
变量	有跌倒史	无跌倒史	有跌倒史	无跌倒史	χ²/Z/t值^a	P值^a	χ²/Z/t值^b	P值^b
GDS-15/n					1.814	0.354	6.640	0.035
无抑郁	11	31	2	39
有抑郁	4	4	3	6
ICI-Q-SF评分	0(0, 3)	0(0, 0)	0(0, 3)	0(0, 3)	-2.521	0.012	-0.215	0.875
MFS评分	25(0, 55)	20(0, 30)	60(35, 67.5)	50(25, 75)	-1.575	0.115	-2.731	0.011
FI	0.11(0.09, 0.24)	0.07(0.04, 0.16)	0.13(0.10, 0.24)	0.09(0.04, 0.11)	-2.544	0.011	-1.758	0.041
RAPA
部分1	3(1, 3)	3(2, 4)	3(2, 4)	3(3, 3)	-0.840	0.401	-0.148	0.900
部分2	0(0, 2)	0(0, 0)	0(0, 1.5)	0(0, 0)	-2.068	0.039	-0.778	0.706
SF-36
PF	55(25, 75)	75(35, 90)	55(42.5, 75)	80(70, 90)	-1.306	0.191	-2.113	0.032
RP	0(0, 0)	50(0, 100)	25(0, 100)	100(100, 100)	-2.540	0.011	-2.841	0.069
BP	64(50, 100)	74(52, 100)	51(16, 100)	100(72, 100)	-0.688	0.492	-1.300	0.240
GH	45(25, 75)	65(50, 77)	50(27.5, 68.5)	70(55, 72)	-1.728	0.084	-1.633	0.108
VT	55.33±22.16	75.43±19.57	52.00±11.51	63.44±14.61	-3.199	0.002	-1.689	0.098
SF	37.5(25, 75)	75(50, 100)	87.5(43.75, 100)	100(100, 100)	-2.689	0.007	-2.682	0.075
RE	0(0,0)	100(0, 100)	100(0, 100)	100(100, 100)	-2.454	0.014	-3.341	0.180
MH	72(64, 96)	88(68, 96)	88(46, 90)	88(80, 92)	-1.460	0.144	-0.643	0.550
HT	25(0, 25)	25(25, 50)	25(25, 37.5)	50(25, 50)	-1.273	0.203	-1.991	0.081
PCS	44.8(30, 66.3)	66.5(39.8, 88)	34.3(28.9, 84)	84(70.3, 89.3)	-2.054	0.040	-1.877	0.059
MCS	45.3(33.8, 58.1)	76.4(52.1, 92)	81(33.5, 88)	88(86, 89.5)	-2.902	0.004	-1.839	0.069
MUNSH评分	39(32, 46)	44(40, 46)	44(10.5, 48)	46(43, 48)	-2.089	0.037	-0.746	0.488
握力/kg	19.5(15.1, 30.6)	23.5(18.3, 32.6)	11.7(6.3, 14.6)	18.7(15.9, 24.5)	-1.217	0.223	-3.056	0.001
腰臀比	0.90(0.88, 0.94)	0.96(0.90, 0.99)	0.93(0.85, 1.0)	0.9(0.88, 0.94)	-2.540	0.011	-0.857	0.412
臂围/cm	24(22.5, 26)	26(24, 29)	29(26.5, 33.5)	27(25, 29)	-2.179	0.029	-1.434	0.159
腿围/cm	28.73±3.17	31.74±2.94	33.40±4.92	33.68±3.22	-3.241	0.002	-0.174	0.863
视力/n					1.236	0.266	0.001	0.690
完好	6	20	2	18
受损	9	15	3	27
听力/n					2.043	0.211	0.265	0.524
完好	13	34	4	31
受损	2	1	1	14

表3

表4

表5

表6

表7

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变量	住院老年人(n=50)		社区老年人(n=50)		χ²/Z值^a	P值^a	χ²/Z值^b	P值^b
变量	有跌倒史	无跌倒史	有跌倒史	无跌倒史	χ²/Z值^a	P值^a	χ²/Z值^b	P值^b
性别/n					0.192	0.662	2.862	0.112
男	8	21	0	17
女	7	14	5	28
年龄/岁	74(69, 80)	69(63, 74)	73(71.5, 78.0)	75(71.5, 77.5)	-2.434	0.015	-0.423	0.672
居住方式/n					0.828	0.346	0.166	0.546
其他	13	33	4	39
独居	2	2	1	6
能生活自理/n	12	35	5	44	7.447	0.023	0.113	0.900
婚姻/n					1.090	0.520	0.566	0.389
已婚	11	30	3	34
其他	4	5	2	11
文化程度/n					1.531	0.372	0.483	0.647
≤ 9年	9	27	5	41
> 9年	6	8	0	4
职业/n					1.077	0.584	0.532	0.766
农民	6	18	2	13
工人	5	7	3	29
其他	4	10	0	3
吸烟/n					2.432	0.296	1.567	0.457
现在吸烟	0	5	0	2
戒烟	5	11	0	9
从不吸烟	10	19	5	34
饮酒/n					0.420	0.811	2.862	0.239
现在饮酒	5	11	0	14
戒酒	3	10	0	3
从不饮酒	7	14	5	28
体育锻炼/n					5.462	0.065	0.237	0.888
现在锻炼	8	17	4	32
中断锻炼	2	0	0	1
从不锻炼	5	18	1	12

项目	住院老年人(n=50)		社区老年人(n=50)		Z/t值^a	P值^a	Z/t值^b	P值^b
项目	有跌倒史	无跌倒史	有跌倒史	无跌倒史	Z/t值^a	P值^a	Z/t值^b	P值^b
白细胞计数/10⁹•L^-1	6(4.9, 6.4)	6.2(4.9, 7.4)	7.4(4.8, 8.7)	5.9(5, 6.7)	-0.975	0.330	-0.906	0.376
红细胞计数/10¹²•L^-1	3.70±0.63	4.12±0.60	4.61±0.46	4.53±0.35	-2.272	0.028	0.409	0.684
红细胞压积	0.33(0.29, 0.40)	0.39(0.35, 0.43)	0.41(0.38, 0.45)	0.41(0.39, 0.42)	-2.355	0.019	-0.178	0.875
血红蛋白/g•L^-1	112(91, 134)	126(118, 144)	132(128, 146)	134(128, 141)	-0.109	0.014	-0.162	0.875
甘油三酯/mmol•L^-1	1.15(0.86, 1.40)	1.46(1.06, 2.06)	1.31(1.17, 2.07)	1.40(1.11, 1.88)	-1.997	0.045	-0.194	0.851
高密度脂蛋白胆固醇/mmol•L^-1	1.12±0.21	1.18±0.33	1.09±0.11	1.18±0.25	-0.608	0.546	-0.777	0.441
低密度脂蛋白胆固醇/mmol•L^-1	2.74±1.32	2.95±0.68	2.82±0.94	2.18±0.67	0.720	0.476	1.961	0.056
R1/mm	9.1(6.9, 11)	9.2(8, 12.8)	10.6(10.4, 12.5)	11.7(10.1, 13.4)	-0.773	0.439	-0.178	0.875
R2/mm	8.87±3.20	9.08±2.35	10.08±1.79	10.52±2.29	-0.259	0.796	-0.413	0.681
R3/cm²	3.17±1.40	3.45±1.77	3.30±0.51	3.26±0.85	-0.541	0.591	0.109	0.914
L1/mm	9.2(7.4, 10.5)	9.7(7.7, 11.5)	13.4(10.5, 14.0)	11.1(9.2, 13.2)	-0.985	0.325	1.084	0.296
L2/mm	7.97±2.65	9.07±2.44	9.96±1.69	10.8±1.97	-1.423	0.161	-0.916	0.364
L3/cm²	3.14±1.44	3.38±1.88	3.77±0.39	3.21±0.88	-0.451	0.654	1.393	0.170

变量	B	SE	Wald χ²	P值	OR	95%CI
年龄	-0.096	0.042	5.154	0.023	0.908	0.836	0.987
MFS评分	-1.083	0.512	4.476	0.034	0.339	0.124	0.923
FI	-4.087	1.683	5.898	0.015	0.017	0.001	0.454
腿围	0.436	0.157	7.674	0.006	1.547	1.136	2.106
臂围	0.242	0.117	4.294	0.038	1.274	1.013	1.602
SF-36
MCS	0.043	0.015	7.718	0.005	1.044	1.013	1.076
PCS	0.028	0.013	4.336	0.037	1.028	1.002	1.056
RP	0.020	0.009	5.144	0.023	1.020	1.003	1.038
VT	0.047	0.017	7.277	0.007	1.048	1.013	1.085
SF	0.031	0.012	6.925	0.009	1.032	1.008	1.056
RE	0.018	0.007	5.676	0.017	1.018	1.003	1.033
血红蛋白	0.044	0.017	6.450	0.011	1.045	1.010	1.082
甘油三酯	1.485	0.742	4.004	0.045	4.415	1.031	18.913

变量	B	SE	Wald χ²	P值	OR	95%CI
GDS-15	-2.234	0.914	5.970	0.015	0.107	0.018	0.643
MFS评分	-2.722	1.028	7.019	0.008	0.066	0.009	0.492
FI	-20.610	8.663	5.660	0.017	0.000	0.000	0.026
握力	0.369	0.143	6.640	0.010	1.446	1.092	1.914
SF-36
PCS	0.052	0.021	5.859	0.016	1.053	1.010	1.098
MCS	0.067	0.027	6.270	0.012	1.069	1.015	1.126
RP	0.028	0.011	6.142	0.013	1.028	1.006	1.051
SF	0.047	0.021	5.066	0.024	1.049	1.006	1.093
RE	0.034	0.014	6.150	0.013	1.034	1.007	1.062
MUNSH 评分	0.076	0.036	4.487	0.034	1.079	1.006	1.157

变量	1年内有跌倒史	1年内无跌倒史	Z/t值	P值
SF-36
PCS	43(30.4, 69.1)	78.1(61.3, 88)	-3.577	< 0.001
MCS	45.6(33.5, 76.3)	86.5(73.4, 90)	-4.218	< 0.001
PF	55(31.3, 75)	75(65, 90)	-2.567	0.010
RP	0(0, 18.75)	100(25, 100)	-4.289	< 0.001
BP	63(29, 100)	84(62, 100)	-1.723	0.085
GH	45(26.3, 70.3)	67(50, 74.3)	-2.532	0.011
VT	54.50±19.80	68.69±17.87	-3.108	0.002
SF	50(28.1, 87.5)	100(75, 100)	-4.367	< 0.001
RE	0(0, 100)	100(100, 100)	-4.328	< 0.001
MH	74(61, 91)	88(80, 92)	-1.824	0.068
HT	25(6.3, 25)	25(25, 50)	-2.868	0.004
MUNSH评分	39.5(30.5, 46)	45.5(42, 48)	-2.699	0.007

社区与住院老年人跌倒的现状及影响因素

Status and related factors of fall among the elderly in community and hospital

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项目	住院老年人(n=50)	社区老年人(n=50)	χ²/Z值	P值
跌倒史/n			6.250	0.012
是	15	5
否	35	45
MFS评分	35(18.75, 35)	20(0, 35)	-3.132	0.002
因跌倒住院史/n			6.383	0.013
是	6	0
否	44	50

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