FALLS IN THE NURSING-HOME
FALLS IN THE NURSING-HOME
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DOI：
10.7326/0003-4819-121-6-199409150-00009
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发表时间：
1994-09-15
影响因子：
39.2
通讯作者：
ROBBINS, AS
中科院分区：
文献类型：
--
作者：
RUBENSTEIN, LZ;JOSEPHSON, KR;ROBBINS, AS
目的：回顾疗养院中跌倒和跌倒相关伤害的流行病学和原因，为临床医生提供一个结构化的框架来评估和治疗有跌倒风险的养老院居民。数据来源：回顾了所有记录养老院跌倒发生率、原因、危险因素和预防策略的大型已发表研究。结果：养老院的平均跌倒发生率为每年每张病床1.5次（范围为0.2至3.6次）。最常见的诱发原因包括步态和平衡障碍、虚弱、头晕、环境危害、思维混乱、视力障碍和体位性低血压。导致跌倒和受伤的最重要的潜在风险因素包括这些因素中的一些和其他因素，如下肢无力、步态和平衡不稳定、视力不佳、认知和功能障碍、镇静和精神活性药物。人们尝试了许多预防跌倒的策略，成败参半。最成功的方案考虑了跌倒的多因素原因，并包括干预措施，以改善力量和功能状态，减少环境危害，并允许工作人员识别和监测高风险居民。通过使用束缚物来减少活动的策略已被证明弊大于利，应该避免。结论：有针对性的病史和跌倒后的体格检查通常可以确定跌倒的直接潜在原因和危险因素。此外，养老院的定期评估可以帮助识别高风险患者，然后针对他们进行特定的治疗和预防策略。
Objective: To review the epidemiology and causes of falls and fall-related injuries in nursing homes and to provide clinicians with a structured framework to evaluate and treat nursing home residents at risk for falls.Data Sources: All large-scale published studies documenting incidence, causes, risk factors, and preventive strategies for falls in nursing homes were reviewed.Results: The mean incidence of falls in nursing homes is 1.5 falls per bed per year (range, 0.2 to 3.6 falls). The most common precipitating causes include gait and balance disorders, weakness, dizziness, environmental hazards, confusion, visual impairment, and postural hypotension. The most important underlying risk factors for falls and injuries include some of these same items and others, such as lower-extremity weakness, gait and balance instability, poor vision, cognitive and functional impairment, and sedating and psychoactive medications. Many strategies for the prevention of falls have been tried, with mixed success. The most successful consider the multifactorial causes of falls and include interventions to improve strength and functional status, reduce environmental hazards, and allow staff to identify and monitor high-risk residents. Strategies that reduce mobility through use of restraints have been shown to be more harmful than beneficial and should be avoided.Conclusions: A focused history and physical examination after a fall can usually determine both the immediate underlying causes of the fall and contributing risk factors. In addition, regular evaluations in the nursing home can help identify patients at high risk who can then be targeted for specific treatment and prevention strategies.