Falls And Fall-related Factors Among Patients Maintained On Hemodialysis

ObjectiveThe purpose of this study is to determine the fall incidence of patients maintained on hemodialysis in Jiangsu region,summarize the fall characteristics such as locations,reasons,positions and severity of injurie,identify the fall-related factors through a cross-sectional and multi-center research method,analyze the general law of the fall occurrence,select groups with high risk of falls so as to provide reference for clinical staffs to implement safety management.Objects and MethodsPart I:Investigation on the incidence and impact factors of falls among patients maintained on hemodialysis:a multicenter studyAn interview based survey was conducted to determine the fall incidence during past 12 months.Fall characteristics including locations,positions,reasons and severity of injuries were recorded for analyzing if the answer is "yes,I had fallen".General information were collected through interviewing face to face,searching electronic health record database and scale assessment Finally,logistic regression was used to analyze the fall-related factors.Part ii:A comparative study on the incidence and impact factors of falls between elderly and middle-aged hemodialysis patientsOn the basis of preliminary investigation,total dialysis patients were divided into two groups,elderly group and middle-aged group respectively according to age.Fall incidence and related factors were calculated by SPSS24.0,compared between the two groups to find the similarities and differences.Results1.A total of 1308 dialysis patients were recruited based on the study criteria and accepted the interview.There were 182 patients among them that reported have least a fell during past 12 month.Overall prevalence of self-reported fall was 13.9%.2.Home floor,road,hospital floor and toliet were the top four locations with highest fall incidence.Physical discomfort slipping,stumble and careless of transfering were the top four reasons of falls.The leg,head and face,sacrococcygeal region and upper limb were the most vulnerable positions of falls.Additionally,muscle contusion,skin abrasion,fracture and hairline fracture were the main consequence of damage.Multivariate analysis results demonstrated that age≥65,dialysis age≥10 years,IDH,Tinetti score<19,secondary hyperparathyroidism and ADL score<60 were independent predictors of fall risk in adult dialysis patients.3.Through comparation,the fall incidence among elderly dialysis patients was far more than middle-aged patients(23.2%vs 10.7%).Three indepented fall-related factors poor balance and gait,secondary hyperparathyroidism and poor sight or hearing were identified among elderly dialysis patients,among which only calcitriol use was relevant to hemodialysis.What’s more,six independent fall-related factors dialysis age≥10 years,secondary hyperparathyroid ism,chronic pain,prone to have IDH,auxiliary instrument use and ADL score<60 were identified among middle-aged dialysis patients,among which dialysis age,secondary hyperparathyroidism,IDH were both correlative to hemodialysis treatment directly,chronic pain may have indirect contact with hemodialysis.The common independent fall-related factor between two groups was secondary hyperparathyroidism.ConclusionFalls were highly prevalent among patients maintained on hemodialysis.Dialysis patients who aged 65 or older,dialysis age≥10 years,prone to occur IDH,with Tinetti score<19 or ADL score<60,and accompany with secondary hyperparathyroidism may have higher risk of falls.Elderly dialysis patients have higher fall incidence than middle-aged patients.Middle-aged patients have more independent fall-related factors and prone to influenced by dialysis treatment,secondary hyperparathyroidism is the common impact factor between two groups.Through investigation on fall incidence,characteristics and related factors among patient maintained on hemodialysis,this study can remind clinical staffs of attaching importance to prevention of unexpected fall,provide guidance for screening dialysis patients at high fall risk,contribute to determining targeted fall prevention strategies and safety management in dialysis room and community.