Risk factors associated with injury attributable to falling among elderly population with history of stroke.
Risk factors associated with injury attributable to falling among elderly population with history of stroke.
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DOI：
10.1161/strokeaha.109.559195
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发表时间：
2009-10
期刊：
影响因子：
8.3
通讯作者：
Luft AR
中科院分区：
文献类型：
--
作者：
Divani AA;Vazquez G;Barrett AM;Asadollahi M;Luft AR
中风幸存者跌倒的风险很高。确定易使中风患者跌倒的身体、临床和社会因素可能会减少进一步的残疾和危及生命的并发症，并提高整体生活质量。我们使用了来自健康和退休研究的5个两年一次的WAVE(1998-2006)来评估中风幸存者中与跌倒事故和跌倒相关伤害相关的危险因素。我们提取了人口统计数据、生活状况、自我评估的总体健康状况和共病情况。采用多因素随机效应模型分析两年内跌倒的发生率比(RR)和受伤的OR。我们确定了1174名中风幸存者(平均年龄±SD，74.4±7.2岁；53%为女性)。在受试者中，跌倒、继发性伤害和髋关节骨折的2年风险分别为46%、15%和2.1%。与跌倒频率增加相关的因素是：与独居相比，与配偶同居(RR，1.4)，一般健康状况较差(RR，1.1)，首次中风时间(RR，1.2)，精神问题(RR，1.7)，尿失禁(RR，1.4)，疼痛(RR，1.4)，运动障碍(RR，1.2)，以及既往≥3跌倒的频率(RR，1.3)。与跌倒相关损伤相关的危险因素有女性(OR，1.5)、一般健康状况差(OR，1.2)、既往跌伤史(OR，3.2)、≥3跌倒史(OR，3.1)、精神问题(OR，1.4)、尿失禁(OR，1.4)、听力受损(OR，1.6)、疼痛(OR，1.8)、运动障碍(OR，1.3)、多次中风(OR，3.2)。这项研究证明了中风幸存者中跌倒和跌倒相关伤害的高患病率，并确定了增加风险的因素。改变这些因素可能会预防跌倒，这可能会提高这一人群的生活质量，减少照顾者的负担和成本。
Stroke survivors are at high risk for falling. Identifying physical, clinical, and social factors that predispose stroke patients to falls may reduce further disability and life-threatening complications, and improve overall quality of life. We used 5 biennial waves (1998–2006) from the Health and Retirement Study to assess risk factors associated with falling accidents and fall-related injuries among stroke survivors. We abstracted demographic data, living status, self-evaluated general health, and comorbid conditions. We analyzed the rate ratio (RR) of falling and the OR of injury within 2 follow-up years using a multivariate random effects model. We identified 1174 stroke survivors (mean age±SD, 74.4±7.2 years; 53% female). The 2-year risks of falling, subsequent injury, and broken hip attributable to fall were 46%, 15%, and 2.1% among the subjects, respectively. Factors associated with an increased frequency of falling were living with spouse as compared to living alone (RR, 1.4), poor general health (RR, 1.1), time from first stroke (RR, 1.2), psychiatric problems (RR, 1.7), urinary incontinence (RR, 1.4), pain (RR, 1.4), motor impairment (RR, 1.2), and past frequency of ≥3 falls (RR, 1.3). Risk factors associated with fall-related injury were female gender (OR, 1.5), poor general health (OR, 1.2), past injury from fall (OR, 3.2), past frequency of ≥3 falls (OR, 3.1), psychiatric problems (OR, 1.4), urinary incontinence (OR, 1.4), impaired hearing (OR, 1.6), pain (OR, 1.8), motor impairment (OR, 1.3), and presence of multiple strokes (OR, 3.2). This study demonstrates the high prevalence of falls and fall-related injuries in stroke survivors, and identifies factors that increase the risk. Modifying these factors may prevent falls, which could lead to improved quality of life and less caregiver burden and cost in this population.