Predictors and prognosis of inability to get up after falls among elderly persons.
Predictors and prognosis of inability to get up after falls among elderly persons.
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DOI：
10.1001/jama.1993.03500010075035
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发表时间：
1993-01
期刊：
影响因子：
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通讯作者：
M. Tinetti;Wen-Liang Liu;Elizabeth B. Claus
中科院分区：
文献类型：
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作者：
M. Tinetti;Wen-Liang Liu;Elizabeth B. Claus
目的 确定与跌倒后无法起身相关的预测因素和预后。设计平均 21 个月随访的队列研究。设置 一般社区。对象 1103 康涅狄格州纽黑文市 72 岁及以上的居民，他们能够遵循简单的命令并无需协助即可行走。主要观察指标 自我报告跌倒后无法在没有帮助的情况下站起来，但未造成严重伤害；跌倒后限制活动并住院；死亡;并安置在疗养院。结果 596 次非伤害性跌倒中，有 220 次在没有帮助的情况下无法站起来。在 313 名未受伤的跌倒者中，有 148 名（47%）表示在至少一次跌倒后无法站起来。与非跌倒者相比，与无法起身独立相关的风险因素包括：年龄至少 80 岁（调整相对风险 [RR]，1.6；95% 置信区间 [CI]，1.2 至 2.1）；抑郁症（RR，1.5；CI，1.1 至 2.0）；平衡和步态较差（RR，2.0；CI，1.5 至 2.7）。既往卒中（RR，1.6；CI，1.0至2.4）和镇静剂使用（RR，1.5；CI，0.9至2.2）未达到显着性。在跌倒者中，年龄较大、平衡能力和步态不佳与无法起身有一定关系。与能够起身的跌倒者相比，无法起身的跌倒者更有可能出现日常生活活动持续下降的情况（35% vs 26%）。与能够起身的跌倒者相比，无法起身的跌倒者更有可能死亡、住院、日常生活活动能力下降至少 3 天，并且被安置在疗养院的可能性更小，但这些趋势并不具有统计学意义。结论 无法起身的风险因素与跌倒的风险因素相似，尽管某些因素会带来在没有帮助的情况下无法起身的特殊风险。无法起床的频率以及与这种无法起床相关的短期和长期发病率表明需要采取预防和治疗措施。
OBJECTIVE To identify the predictors and prognosis associated with inability to get up after falling. DESIGN Cohort study with a mean 21-month follow-up. SETTING General community. SUBJECTS 1103 New Haven, Conn, residents aged 72 years and older who were able to follow simple commands and walk unassisted. MAIN OUTCOME MEASURES Self-reported inability to get up without help after falls not resulting in serious injury; activity restriction and hospitalization after a fall; death; and placement in a nursing home. RESULTS Inability to get up without help was reported after 220 of 596 non-injurious falls. Of 313 non-injured fallers, 148 (47%) reported inability to get up after at least one fall. Compared with non-fallers, the risk factors independently associated with inability to get up included the following: an age of at least 80 years (adjusted relative risk [RR], 1.6; 95% confidence interval [CI], 1.2 to 2.1); depression (RR, 1.5; CI, 1.1 to 2.0); and poor balance and gait (RR, 2.0; CI, 1.5 to 2.7). Previous stroke (RR, 1.6; CI, 1.0 to 2.4) and sedative use (RR, 1.5; CI, 0.9 to 2.2) did not achieve significance. Among fallers, older age and poor balance and gait were associated marginally with inability to get up. Compared with fallers who were able to get up, fallers who were unable to get up were more likely to suffer lasting decline in activities of daily living (35% vs 26%). Fallers who were unable to get up were more likely to die, to be hospitalized, and to suffer a decline in activities of daily living for at least 3 days, and were less likely to be placed in a nursing home than were fallers who were able to get up, but these trends were not statistically significant. CONCLUSIONS The risk factors for inability to get up were similar to those for falling, although certain factors imparted a particular risk of inability to get up without help. The frequency of inability to get up and the short- and long-term morbidity associated with this inability suggest the need for preventive and treatment efforts.