| ObjectiveIn this part,we study the elderly residents in 9 communities of Qingdao urban area and Huangdao District,comprehensively assess the current situation of the fall of the elderly in Qingdao communities,investigate the prevalence of falls among the population,and explore the relationship between various risk factors such as comprehensive health statues,motor function and gait in the elderly and the occurrence of falls.And further observed the intervention effect of different rehabilitation intervention modes(anti-fall health education,balanced training,vitamin D injection,etc.)on risk factors of fall of the elderly in 120 elderly patients with high risk of falls,and discuss the feasibility and effectiveness of the comprehensive intervention of falls.To provide the most basic data for the development of the elderly fall risk assessment and intervention program which is suitable for our country's national conditions and characteristics,and to provide a strong theoretical support for the government to formulate a reasonable prevention strategy and to protect public health.There was still not a suitable comprehensive evaluation tool for evaluating the fall risk of hospitalized elderly patients in China,and mainly using the foreign falls assessment scale,the application of these scales of fall assessment were not fully evaluated in Chinese hospitalized elderly patients.In this study,we used stratify,Hendrich II fall risk model and Morse fall assessment scale to evaluate the fall risk of old inpatients,to explore their discriminant validity and correlation,to select the risk assessment tool for the patients,and to screen the fall risk group,to reduce the blindness of fall prevention and intervention measures,and to provide an objective basis to effectively reduce the incidence of falls.MethodsThe cross-sectional study was carried out to investigate the comprehensive health status and risk factors of the population in 1716 cases(male 795 and female 921)by means of epidemiological questionnaire and to determine the exercise function and static balance.The questionnaires included general demographic data,lifestyle,chronic diseases,history of medication,history of falls and physical examination data,etc.Functional assessment included Timed up and Go testing(TUGT)and measurement of static balance.And then a further 3 months intervention was based on the previous study in 120 high risk elderly patients who had a history of fall previously.These 120 patients randomly divided into 4 groups: balanced training + anti-fall education Group(EE group),vitamin D + anti-fall education Group(DE Group),anti-fall education Group(OE Group),blank control group(P Group)? The same assessment was conducted after 3 monthsintervention.In the Third study,200 cases of old patients in health ward and geriatric ward were selected by means of convenient sampling.The subjects were investigated in general condition and were explained the related information of scales.the stratify,Hendrich II fall risk model and the Morse fall assessment scale were evaluated successively.To ensure the consistency of the assessment results,the entire investigation process was evaluated by the researcher and a graduate student.Patients completed the fall risk assessment scale on the day of admission(within 24 hours),and then evaluated once a week.Epidemiological surveys and data collection are conducted by trained professionals.Data entry adopts double input method to ensure the accuracy of data.All data analyzed by statistical analysis software SPSS23.0.Results1.The study included 1716 subjects,the subjects were 65-88 years old,the average age was 72.2 ± 7.1.Among them,795 males,average age 72.9 ± 6.8,921 females,average age 71.2 ± 7.4.2.Among the subjects,there were 412 people with a history of falls,which accounted for 24% of the total,of whom 172 were males,21.6%,and 240 were females,26.1%.As the age increases,the incidence of annual falls in male and female elderly people increases gradually.Among the group of older persons over 70 years old,the incidence of female falls was significantly higher than that of male,and there were statistically significant differences(p<0.05).3.In the elderly people who fall,the number of male falls was similar than that of female.The proportion of female fractures after fall was significantly higher than that of male(31.3%&17.4%),(p<0.05).4.There were significant differences in fall Group and non-fall Group in the age(78.6 ± 7.3&72.1±8.1),motor function(TUGT)(23.1±11.4s&17.9±7.1s),static balance determination(TTW: 121.7±43.1mm&90.7±28.1mm,EA: 12.1±8.3 mm2&8.1±4.6 mm2)(p<0.05).5.Single factor logistic regression analysis showed that the risk factors for the fall of the elderly group included: Age,sex,multiple disease status,motor ability(TUGT),balance function(TTW,EA),diabetes mellitus,coronary heart disease,arrhythmia,osteoarthritis,incontinence,visual abnormality,vertigo/syncope,respiratory diseases,digestive system diseases(p<0.05).Multi-factor logistic regression analysis showed that the risk factors for the fall of the elderly group included: age,sex,decreased in motor ability(i.e.TUGT completion time extension),decreased in balance function(i.e.gait and balance disorder,TTW,EA Increased),Chronic condition(visual abnormality,coronary heart disease,arrhythmia,vertigo/ syncope,diabetes,respiratory diseases,osteoarthritis)(p<0.05).6.After the intervention,the improvement of the TUGT and static balance was significantly different in EE group(p<0.05).7.After the intervention,the improvement of the static balance of DE Group was significantly different(p<0.05),and TUGT was not significantly changed compared with the control group.8.In terms of daily activity and quality of life,EE Group,DE Group and OE group were improved,and the improvementof EE group was significantly higher than that of other groups(p<0.05).9.The scores of fall group in stratify and Hendrich II fall risk model were higher than those of non fall group,which had statistical difference(p<0.05).The scores of Morse fall assessment Scale(MFS)in the fall group were significantly higher than those in the non-fall group,and the difference was significant(p<0.01).10.By comparing the reliability validity of these three scales,the sensitivity of Morse fall assessment scale(MFS)was the highest,but the specificity was the lowest,the specificity of stratify scale was the highest,but the sensitivity was the lowest,and the sensitivity and specificity of Hendrich II risk model were the most balanced.11.Stratify and Hendrich II Fall risk models were highly correlated,and stratify and MFS scales were highly correlated.The Hendrich II Fall risk model was also highly correlated with the MFS scale(p<0.01).Conclusion:1.The prevalence of falls was 24% in the elderly population;2.As the age increases,the incidence of annual falls in male and female elderly people increases gradually.Among the group of older persons over 70 years old,the incidence of female falls was significantly higher than that of male.3.The proportion of female fracture after fall was significantly higher than that of male;4.Fall is the result of a combination of multiple risk factors,elderly women,multiple disease status(diabetes,coronary heart disease,arrhythmia,visual impairment,vertigo,respiratory diseases,osteoarthritis),the people who decreased exercise ability and had abnormal gait were high risk group of fall and should pay more attention.5.Anti-fall health education + balanced training can effectively improve the movement ability,balance function,life quality and daily life ability of the old group,it is the rehabilitative intervention which is worth popularizing.6.Stratify,Hendrich II fall risk model and Morse fall scale had a high correlation in assessing the risk of falls in the elderly,and three scales had a good consistency in assessing the occurrence of falls.7.The emphasis of the three scales was different.In clinic,nursing staff should use these scales according to the characteristics and needs of the elderly. |
PDF Full Text Request