THE CONTRIBUTION OF PREDISPOSING AND SITUATIONAL RISK-FACTORS TO SERIOUS FALL INJURIES
THE CONTRIBUTION OF PREDISPOSING AND SITUATIONAL RISK-FACTORS TO SERIOUS FALL INJURIES
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DOI：
10.1111/j.1532-5415.1995.tb07395.x
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发表时间：
1995-11-01
影响因子：
6.3
通讯作者：
CLAUS, EB
中科院分区：
文献类型：
--
作者：
TINETTI, ME;DOUCETTE, JT;CLAUS, EB
目的：目的是确定与遭受严重跌倒伤害相关的情境危险因素，并确定是否以及在何种程度上，诱发因素和情境危险因素独立地对遭受严重跌倒伤害的风险做出贡献。568名72岁或以上的社区生活者的代表性样本成员在中位随访36个月期间跌倒。在基线面对面家庭评估期间确定的候选易感因素是与先前队列分析中跌倒者严重损伤风险增加相关的人口统计学、认知、医学和身体表现指标。急性宿主，行为和环境因素在参与者首次报告跌倒时构成了潜在的情境风险因素。主要结果是发生严重的跌倒损伤，定义为骨折，关节脱位，或头部损伤导致意识丧失和住院治疗，在第一次下跌记录在follow-up.RESULTS：六十九名受试者（12%）遭受了严重的伤害，在他们的第一次报告下降。急性宿主因素与损伤风险增加无关。在多变量分析中，与严重损伤独立相关的环境和活动因素包括在楼梯上跌倒（校正的相对危险度2.0; 95%置信区间1.1 - 3.5），在移位活动中跌倒（1.8; 1.0 - 3.0），以及从至少身高（2.1; 1.0 - 4.7）跌倒。独立的诱发因素包括女性（2.1; 1.0 - 4.4）、低体重指数（1.8; 1.2 - 2.9）和认知障碍（2.8; 1.7 - 4.7）。虽然12%的第一次福尔斯跌倒导致严重伤害，但当诱发风险因素从0增加到3时，这一比例从0%增加到36%，当情境风险因素从0增加到3时，这一比例从5%增加到40%。此外，对于任何给定数量的诱发危险因素，跌倒者遭受严重伤害的百分比增加的情景危险factorsCONCLUSIONS：几个环境和行为因素导致严重跌倒伤害的风险，这种贡献是独立的慢性诱发危险因素的影响。预防计划，解决诱发和情境风险因素可能会导致最大的伤害减少。这些研究结果支持以前推荐的多组分干预计划，结合联合收割机医疗，康复和环境组件。
OBJECTIVES: The objectives were to identify situational risk factors associated with suffering a serious fall injury and to determine whether, and to what extent, predisposing and situational risk factors contributed independently to risk of suffering a serious fall injury.DESIGN: Nested cohort study.SETTING: General community.PARTICIPANTS: 568 members of a representative sample of community-living persons 72 years of age or older who fell during a median follow-up of 36 months.MEASUREMENTS: Candidate predisposing factors, identified during a baseline face-to-face home assessment, were the demographic, cognitive, medical, and physical performance measures associated with an increased risk of serious injury among fallers in a previous analysis of the cohort. Acute host, behavioral, and environmental factors present at the time of the participants' first reported fall constituted potential situational risk factors. The primary outcome was occurrence of a serious fall injury, defined as a fracture, joint dislocation, or head injury resulting in loss of consciousness and hospitalization, during the first fall recorded during follow-up.RESULTS: Sixty-nine subjects (12%) suffered a serious injury during their first reported fall. No acute host factor was associated with increased risk of injury. The environmental and activity factors associated independently with serious injury in multivariate analysis included falling on stairs (adjusted relative risk 2.0; 95% confidence intervals 1.1 - 3.5), during displacing activity (1.8; 1.0 - 3.0), and from at least body height (2.1; 1.0 - 4.7). The independent predisposing factors included female gender (2.1; 1.0 - 4.4), low body mass index (1.8; 1.2 - 2.9), and cognitive impairment (2.8; 1.7 - 4.7). Although 12% of first falls resulted in a serious injury overall, this percentage ranged from 0% to 36% as the number of predisposing risk factors increased from zero to three and from 5% to 40% as the number of situational risk factors increased from zero to three. Further, for any given number of predisposing risk factors, the percentage of fallers suffering a serious injury increased with the number of situational risk factorsCONCLUSIONS: Several environmental and behavioral factors contributed to the risk of serious fall injury; this contribution was independent of the effect of chronic predisposing risk factors. Preventive programs that address both predisposing and situational risk factors may result in the greatest injury reduction. These findings support previously recommended multicomponent intervention programs that combine medical, rehabilitative, and environmental components.