| 1.BackgroundFalls is the important public health issue which threatens the helath of adults in older age seriously.Based on the report from World Health Organization,estimated 28%to 35%adults aged 65 years old and above fall at least once in one year.Falls not only affect the physical and mental health of adults in older age,but also caused the huge burden.In China,at least 25 million falls occur among 20 million in older age,and the direct medical expenses above 5 billion yuan RMB.Zhejiang Province,located in the southern part of Yangtze River Delta of the southeast coast of China,There are 90 counties(including districts at county level),11 cities and the total population is 54.43 million by the data from The Sixth National Census in 2010.5.08 million residents aged 65 years and above and the proportion was about 9.34%which is higer than the national average level.Falls is the top deatch causes by injury in older age in Zhejiang.The mortality rate of falls among residents aged 65 years and above in 2013 was 38.10 per 100 000 population.There are few studies on the status quo or intervention of falls in older age in Zhejiang,therefore,the epidemiological features and mainly risk factors of falls in older age can not be obtained.The aims of the study is to know the epidemiological features and risk factors among resicdents aged 60 years old and above and to provide scientific evidence for the strategy and targeted measures of falls prevention in older age.2 Objects and methods2.1 Objects2 districts named Cixi city and Fuyang district were selected.Based on the Sample size determination,the inclusion and exclusion criteria,1000 adults aged 60 years old and above were selected by the methods of the stratified and cluster random sampling.2.2 Contents and methodsQuestionnaire survey and environmental evalusition were included in this study.The sheets named the situation on falls among community-dwelling older adults were used to interview the each object by method of household survey.The main contents of the sheets were including basic personel information,the occurrence of falls,the health status,the KAP of falls prevetion,the daily living ability evaluation and so on.The environmental evaluation was done for each family by the sheets named the assessment of environmental risk factors related falls in living and total 40 factors of passageway,living room,bedroom,toilet,kitchen,balcony,yard were evalued.2.3 Definition2.3.1 FallsFalls is the in-advertently coming to rest on the ground,floor or other lower level,excluding intentional change in position to rest in furniture,wall or other objects.According to International Disease Categeries(ICD-10),falls includes(1)fall from one level to another level,(2)falls on same level.2.3.2 Operational Definition of falls injury Falls occurs and either of following 2 conditions was meet can record falls injury1)Diagnosed by doctos as injured by falls in hospitcal2)Injured and have a rest 1 day and above caused by falls2.4 Data collection and statistical analysisAll the sheets of the study were written by trained investigators.All the variances of quantitative questionnaire were coded unified and the database was estabilished by Epidata 3.02 software.Tthe descriptive analysis,univariate analysis and multivariate logistic regression were used and odds ratio and its 95%confident interval and P index were used as analysis indexes by Spss 19.0 software.The incidence of falls and falls injury were adjusted by the data of Sixth National Census in 2010.The contents of analysis included(1)the incidence and epidemiological features of falls among community-dwelling older adults,(1)the environmental related risk factors of falls in living among community-dwelling older adutls,(3)the risk fators analysis of falls among community-dwelling older adults.3 Results3.1 The epidemiological features of falls among community-dwelling older adults 2002 community-dwelling older adults were interviewed and 1943 questionnaires were collected,the proportion was 97.05%.909 were males and 1043 were females.389 falls occurred from 316 adults in older age during November 2012 to October 2013.The incidence of falls was 16.26%and the adjusted rate 16.00%by the data of Sixth National Census in 2010.The incidence of falls among females(18.96%)was higher than that among males(13.20%).The incidence of falls increased with the age growing.Falls mainly occurred at daytime,the main activities when falls occurred were houseworking(22.37%),going up and down(11.83%)and walking outside(11.83%).The main places where the falls occurred are stairs/passageway(16.71%),road(12.85%),other public places out of the community(14.65%).The self-reported the self reasons for falls were can not keep balance(31.62%),lack of concentration(22.37%)and feebleness of the knees(20.82%)while the environmental reasons for falls were uneven pavement(20.31%),slippery(18.77%)and obstacles in the way(13.62%).71.20%older adults injured and the incidence was 11.58%(the adjusted rate was 11.34%).48.25%older adults hurt their lower limbs and the nature of injury were contusion/scratch(41.63%),sprain/strain(32.30%)and fracture(14.40%).The proportion of fracture among females was higher than that among males.77.44%hurt light and the proportion of moderate and serious level of injury was 16.34%and 6.23%.The proportion of functional impairment and disabled caused by falls were 7.00%and 1.95%.3.2 The environmental factors for falls among community-dwelling 1241 households with older adults were evaluated the environmental factors for falls,592 in urban areas and 649 in rural areas.For the space of passageway,62.50%households had the environmental factors and the pet without a bell(45.81%)and without shoe changing stool(49.80%)were the main issues.For the space of living room,84.72%households had the environmental factors and chairs without armrests(56.68%)and slipper ground(28.29%)were the main issures.For the space of bedroom,69.93%households had the environmental factors and can not answer the phone on bed(52.62%)and did not have double control switch for light(22.07%)were the main issures.For the space of toilet,93.94%households had the environmental factors and did not have the handrail in the bathrub/shower room(75.65%)or no-slip mat(71.95%)and did not have the handrail near the flush toilet(72.60%)were the main issures.For the space of kitchen,37.86%households had the environmental factors and slipper ground(17.80%)was the main issue.For the space of balcony,51.29%households had the environmental factors and slipper ground(20.27%)and had the debris on ground(19.44%)were the main issue.For the space of yard of household in rural areas,40.45%households had the environmental factors and had the debris on ground(36.29%)was the main issue.3.3 Risk factor of falls among community-dwelling older adultsThe falls related factors were assigned and were analyzed by univariate analysis with logistic regression in the level of a=0.1.The results showed that gender,age,education level,living condition,suffering from hypentension,stroke,diabetes,hyperosteogeny,osteoporosis,vertigo,arthritis,Alzheimer's disease,asthma,cataract,lower limb disability,had one or more falls related disease,taking antihypertensive drugs,hypoglycemic drugs,sedative,taking 2 or more types of drugs,vision,smoking,drinking,walking aid using,happiness,using toilet at nighttime,general health situation,having the previous falls history,awareness of falls prevention,reducing activities for fear of falling,exercise situation,lower daily living ability were the potential influence factors.The results of multivariate logistic regression showed that suffering from diabetes(OR=4.965),bad health situation(OR=2.206)and having the previous falls history(OR=25.621)were the potential risk factors and lower awareness rate of falls prevention(OR=0.663),taking hypoglycemic drugs regularly were the potential protective factors.4 ConclusionThe incidence rate of falls among community-dwelling older adults aged 60 years old and above was 16.26%(adjusted rate was 16.00%),and the incidence rate of falls related injury was 11.58%(adjusted rate was 11.34%)which were lower than those in western developed countries and in the middle level in China.Falls in older age had the own epidemiological features,such as the incidence rate among females was higher than that among males,the incidence rate was increasing with age growing,mainly hurt lower limbs,the proportion of moderate or serious injury and the proportion of functional impairment and disabled were high.The main risk factors of falls were suffering from diabetes,bad health situation and having the previous falls history and so on.Falls is the important public health issue which affect the physical and mental health of adults in older age,"5E" intervention strategies and public health methods should be used to prevention.According to the education,rational drug use,moderate exercise,environmental improvement to improve the quality of life and health level of older adults in Zhejiang. |
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