Study On Falls Of Disabled Elderly In Home Care: Fall Risk And Prevention Program

Background Falls are the leading cause of mortality in elderly worldwide, resultingin chronic pain, dysfunction, disability and death. As to the increasing agingpopulation，the incidence of falls continue to rise,becoming a major public-healthconcern. Studies have shown that disability is related to fall incidence. The complicationmake elderly vulnerable to death, which seriously affect the quality of life for the elderly,and to increase the economic burden on families and society. Therefore, it is ofsignificance to learn more about falls. However, studies concentrated on the falls ofdisabled elderly are not enough, Based on the status quo, the studies aim to supportdecision-making for effective and efficient fall prevention must be done.Purpose To investigate the prevalence of falls in disabled else elderly, including fallsincidence, fall risks,etc. A cross sectional study was conducted. To observe thedistribution and risk factors of falls in disabled elderly.To evaluate the effectiveness of amultifactorial home-based fall prevention program designed to decrease fall incidencein the homes of disabled elderly.Methods The program included500disabled adults aged60living at home in twocommunity in haidian district in beijing from february2013to february2014. Fall riskswere investigated for one year by a self-report questionnaire and merop-com.35disabled participants were invovled in the multifactorial prevention program with arandom sample. These disabled elderly received a6month multifactorial interventiontargeting identified fall risks. The program include targeting assesment, health educationindoors, home safety modification, exercise program mobility,medicine simplity, fear offalls intervention and management of assistant tools. Making comparison of the indexesbefore and after6months multifactol intervention.All the data were coded by epidata3.1, and analysed by Spss13.0. χ2test，binary logistic regression analysis, ordinal logistie regression analysis were used to explore related factors for falls in the elderly.Result In the formal survey, we send500questionnaires, the valid questionnaireswere458, and the effective rate reached91.6%.The fall incidence of disabled elderlywas41.5%. Disable woman elderly showed significantly higher rate of falls than men.The slight disabled group showed a significantly higher rate of falls（71.6%）.On thetime and place distribution, most of falls occurred in the morning(28.9%)and in theroom(67.9%).The most outside fall place was the community（37%）.The main intrinsiccause of falls was losing balance（36.8%）,and extrinsic reason was unsteady step（19.1%）.76.3%of disabled elderly suffered a fear of falls. fall-related injuriesaccounted for56.3%,19%resulted in a fracture,35.2%hospitalised,and47.9%had asequelae.27.5%need more than one month to recover.The caregiver were mainly theseelderly’s spouses and childern(58%). The disabled elderly’s konwledge related to fallswas low, but the requirment of hnowledge was high. The multiple logistic regressionanalysis showed12risk factors of fall,including live alone, visual and hearingimpairments，urinary incontinence，diabetes，hypertension，polypharmacy,frequentlyto use the bathroom, gait balance,active body, assistant tools. After6monthsintervention, The group had31.5%fewer falls than before,the rate of fall was14.3%(p<0.05).The sigle feet standing time showed longer,the fear of falling was reduced,butit didn’t show significantly difference. The accuracy rate of knowledge related to fallswere increased from12.7%to93.23%.and the fall risk score had a significantly lower.Interventions to improve home safety appear to be effective.There were19iterms hadsignificant differences before and after intervention (p<0.05).Conclusion Falls are associated with identifiable risk factors, including the level ofdiasablity, live alone, visual and hearing impairments， urinary incontinence andetc.Programmes of multifactorial interventions，including targeting assesment, healtheducation indoors, home safety modification, exercise program mobility and etc,areeffective to reduce the fall amount and fall risks.