The Evaluation Of Fall Risk And Associated Factors In Elderly Patients With Chronic Obstructive Pulmonary Disease In Acute Exacerbation

Objective:This study is aimed to evaluate the fall risk in elderly hospitalized patients with chronic obstructive pulmonary disease in acute exacerbation,and to further study the correlation between fall risk of COPD and its associated factors.Methods:There were 112 elderly hospitalized patients with AECOPD were included in the Department of Elderly Respiratory Medicine inn Shaanxi Provincial People's Hospital.The Morse Fall Scale?MFS?were used to evaluate the fall risk of patients and divide them into the non risk of fall group,the low-risk of fall group and high-risk of fall group,at the same time,Tinetti Gait and Balance Test was used to evaluate the balance function,the Modified Medical Research Council Scale?mMRC?was used to assess the degree of hard breathing of the AECOPD patients.Then comparing general basic information?age,gender,smoking history,living type,marriage history,BMI?,disease related factors?the duration of COPD,the number of exacerbations in nearly a year,the number of chronic diseases,the amount of oral drugs?,clinical laboratory indicators(blood routine:WBC,N%,RBC,Hb;blood gas analysis:PH,PaO_2,PaCO₂;renal function:K⁺,Na⁺,Cl^-,Ca²⁺,fasting blood sugar;FeNO),falls history in 6months,pulmonary function?FEV₁%pred?FEV₁/FVC?,the score of Gait and Balance Test and mMRC between three groups.Following up the event of fall in 6 months,Furthermore,evaluated the value of each influencing factor and MFS score on fall.Results:1.After evaluating 112 cases of elderly AECOPD patients by MFS,there were 78 cases?69.64%?in the high-risk group,29 cases?25.89%?in the low-risk group,and 5 cases?4.46%?in the no-risk group.2.Comparison between the three groups according to the results:the differences of age,the amount of oral drugs,with hypertension,with diabetes mellitus,history of fall in the past half year,balance test score,PaO₂,fasting blood sugar,FeNO and FEV₁%pred had statistical significance?P<0.017 or P<0.05?,while the differences of sex,smoking history,living type,marital status,duration,nearly 1 year the number of exacerbations and other laboratory index,mMRC score and gait balance test total score had no statistical significance?P>0.05?.3.Pairwise comparison between the three groups showed that:the age of patients in the high-risk group was higher than its in the risk-free group?P<0.05?,and the amount of oral drugs,the ratio with hypertension and diabetes mellitu,the ratio of falls history in half a year and FeNO in high-risk gropup were all higher than that in the no-risk group?P<0.05?;The balance test score of the high-risk group was lower than that of the low-risk group?P<0.05?.Patients in the low-risk group had lower PaO₂,FEV₁%pred and fasting blood sugar than those in the no-risk group?P<0.05?.4.mMRC score was negatively correlated with the score of gait?r=-0.353,P<0.001?and balance?r=-0.271,P=0.004?.5.Ordinal logistic regression showed that the age?OR=1.134,95%CI:1.023¹.229,P=0.017?,the amount of oral drugs?4?OR=4.411,95%CI:1.078¹.157,P=0.075².893?,with hypertension?OR=105.399,95%CI:8.150¹468.505,P<0.001?,with diabetes?OR=32.917,95%CI:2.532⁴28.375,P=0.008?,falls history in half a year?OR=47.299,95%CI:4.204⁵30.600,P=0.002?,FeNO?OR=1.057,95%CI:1.004¹.111,P=0.033?were independent risk factors for the assessment of fall risk inpatientswith AECOPD.6.The telephone follow-up results of 54 patients with COPD discharged from hospital showed that there were 4 cases?7.40%?with fall events,3 cases?5.66%?with falling tendency but didn't happened,and 2 cases?3.70%?with assistances.The ROC Curve show that the AUC of hypertension was 0.830?95%CI:0.701⁰.959?,AUC of falls history was 0.610?95%CI:0.316⁰.904?,AUC of FeNO was 0.550?95%CI:0.272⁰.828?,AUC of the amount of drugs was 0.548?95%CI:0.246⁰.849?,AUC of MFS was 0.650?95%CI:0.405⁰.895?.Conclusions:The age,the amount of oral drugs?4,with hypertension,with diabetes,history of falls and rising of FeNO all will increase the fall risk of elderly patients with AECOPD in varying degrees,while the hypertension had a biggest value of prediction of falls;Pulmonary function grading is not yet used to assess the risk of falls in patients with AECOPD.