Risk Assessment Of Falls In Elderly People In The Community And Their Association With Osteoporotic Fractures

PurposeWith the aging of China’s population,the health problems of the elderly are becoming more and more prominent and becoming a hotspot in preventive medicine and clinical medicine research.In the older population,osteoporosis has become common diseases and epidemic,also more and more cause the attention of the state health department,is the main population of osteoporosis in the elderly,old people also fall in high-risk groups at the same time,nearly half of the elderly have fall experience,caused by a fall injury death is one of the leading causes of death in the elderly.And the elderly fall can lead to brittle fracture,osteoporosis caused a series of clinical problems,is one of the important causes of death in the elderly disabled,and obviously increase the medical burden of the elderly.The elderly fall affected by many factors,some can be changed,some can’t change,the domestic in the past research has focused on hospitalized patients that falls on the assessment scale and simple movement balance test means,such as the degree of risk evaluation falls in hospitalized patients,and according to the different risk classification,and then the corresponding intervention.But in real life,fall damage mainly occurs in older people in the community of the elderly,and less domestic research in this field,in the community environment,the influence of the factors become more complex,many factors cannot be changed,and the actual operation and the lack of effective evaluation methods,and also have no way to targeted prevention.But the elderly fall prevention community is to reduce osteoporosis fracture in the elderly,and other relevant damage the key,to the community of the elderly fall risk identification and evaluation is the precondition of effective prevention and intervention.In many domestic and foreign studies,the decline of balance ability and the relationship between osteoporosis and falls are clear.To this end,we designed this study,in the community elderly osteoporosis prevalence and incidence of falls and application of plantar pressure test balance ability assessment of epidemiological investigation,on the basis of discusses the community the elderly fall may be risk factors and some possible predictors.The purpose of our study is to provide new methods and ideas for preventing the fall of elderly people in the community.Methods1.The fall in the community elderly osteoporosis and related knowledge questionnaire and calcaneal bone mineral density measurement,in districts,shibei district,Qingdao licang district and huangdao district through purposeful sampling method,referring to the sixth national population census in Qingdao district population distribution characteristics and proportion,select local old people inhabit the typical 24 community,through the neighborhood and community residents’ committees associated personnel,according to the natural distribution of blocks and the number of elderly people living in each of the buildings,each community randomly selected 100-120 the elderly over the age of 50,and notify is pumped by community residents’ committees of the people,time of concentration within the community inclusion of the elderly over the age of 50 the situation questionnaire survey related to osteoporosis and falls in to understand the prevalence of osteoporosis and falling and awareness,and so on and so forth.The ultrasound and bone densitometer were used to measure the bone density of bone in the right foot and bone in all subjects,and the average was measured twice.2.Double full bottom pressure test: according to the principle of informed consent and voluntary,choose two communities in different districts,more than 60 of them to keep the old test and sign the informed consent,and select a total of 218 over 60(105men and 113 women)there is no history of fall into the group,all the selected objects Footscan plantar pressure distribution under the condition of gait analysis system for static double full bottom pressure test,each subject measured three times,average for recording.At the same time,the demographic characteristics of all selected subjects were recorded,including age,height,weight,foot length,etc.,and the contact information was retained and the follow-up files were established.3.Follow-up: object by a unified training of personnel for follow-up every three months with a telephone follow-up,inquired about whether fall,presence of fractures and other related files and records to follow-up,a total of 2 years of follow-up.Results1.According to Qingdao sixth census district population proportion and actual population of Qingdao in 2014,combining with the characteristics of the distribution of permanent residents and purposefully chose the local permanent residents of the community,including districts four communities,shibei district 8 communities,licang district 4 and huangdao district eight communities,a total of 24 community.According to the natural zoning of buildings and the number of elderly people in each floor,each community randomly selected 100-120,the final total of 24 community of 2682 residents aged 50(including male 781,female 1901)on osteoporosis and fall related situation questionnaire survey and the right foot heel bone ultrasonic bone mineral densitymeasurement.Through data statistical analysis,the result shows: the community overall awareness of osteoporosis in the elderly was 66.3%,in the community for people over the age of 50,osteoporosis(T value is less than 2.5)prevalence was 17.6%(473/2682),the prevalence of women was 19.7%(375/1901),the prevalence of male was 12.6%(98/781);The prevalence of bone mass reduction(T is less than-1)was 60.4%(1619/2682),with 66.2% of women(1258/1901)and 46.2%(361/781).According to the questionnaire,the incidence of falls among the elderly in the neighborhood was 14.6%(392/2682)in the past year,with the incidence rate of women is 17.6%(335/1901)and the incidence rate of men was 7.3%(57/781).The incidence of brittle fracture among the elderly in the community was 4%(107/2682),with the incidence rate of women at 4.7%(87/1901)and 2.7% of men(20/781).The occurrence of falls is obviously related to the gender and osteoporosis fracture.2.The elderly over the age of 60,218 after 2 years of telephone follow-up,statistical subjects that falls happen to fall and fall in comparison,the results suggest that double bottom pressure measurement fully display digits(2-4 toe)area,3-5 metatarsal area,outside parapodum bow(LA)plantar pressure increased significantly and foot pressure imbalance,obviously increase the risk of falls.The incidence of falls in the high pressure group in the toe area increased from 2.75% to 12.84%.The incidence of falls in the higher pressure group in the third metatarsal region increased from 3.67% to 11.93%.The incidence of falls in the higher pressure group in the 5th metatarsal area increased from 4.59% to 11.01%.The incidence of falls in higher pressure groups in LA region increased from 0.92% to 14.68%.Analysis also shows that at the same time,the asymmetric foot pressure,fall risk increases,we found that in two years of follow-up,the asymmetric rating of low(0 to 5),only two people happen to sin,and high asymmetric score(6-10)there are 15 people in fall.The incidence of falls was 3.13%(2/64)in the low rating group,and 9.74%(15/154)in the high evaluation group,and there was a significant difference between the two.3.Patients with osteoporosis had a higher risk of falls,and 62 men(59.05 %)and100 women(88.5%)were diagnosed with osteoporosis.Osteoporosis patients showed a significantly different plantar pressure distribution,compared with non osteoporosis,feet in the middle of the first metatarsal pressure decreased significantly(from 13 k Pa fell to9 k Pa),in the fourth and fifth metatarsal pressure increased significantly(respectively from 6 k Pa and k Pa to 17 k Pa and 10 k Pa,).It is worth noting that the asymmetry of osteoporosis patients foot pressure also increased significantly,the proportion ofperformance in patients with osteoporosis 10 feet nine areas pressure exists obvious difference,but in the osteoporosis patients,only 3 pressure exists obvious difference.During the two years of follow-up,17 people fell,16 of them were osteoporosis and only1 were non-osteoporosis.Therefore,the incidence of falls of osteoporosis was 9.88%(16/162)significantly higher than that of non-osteoporosis patients was1.79%(1/56).Conclusion1.The Qingdao area community among the elderly,osteoporosis prevalence is not optimistic,but older people with osteoporosis awareness is not high,emphasis is a severe lack of,need to be further focus on community elderly bone health,strengthen the knowledge related to osteoporosis in the community publicity among the elderly,increase understanding of osteoporosis,early prevention and control of osteoporosis prevalence increased.2.After two years of follow-up observation,it was confirmed that the changes in the pressure level and osteoporosis were significantly correlated with the risk of falls and falls among the elderly in the community.We can through the community elderly double full bottom pressure measurement and calcaneus ultrasonic bone mineral density measurement of these simple tests to screening high-risk groups that falls early targeted prevention measures,avoid the happening of the elderly fall.3.In the elderly population of the community,the double bottom pressure measurement and osteoporosis monitoring are effective predictors of falls risk.