RISK-FACTORS FOR FALLS AMONG ELDERLY PERSONS LIVING IN THE COMMUNITY
RISK-FACTORS FOR FALLS AMONG ELDERLY PERSONS LIVING IN THE COMMUNITY
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DOI：
10.1056/nejm198812293192604
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发表时间：
1988-12-29
影响因子：
158.5
通讯作者：
GINTER, SF
中科院分区：
文献类型：
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作者：
TINETTI, ME;SPEECHLEY, M;GINTER, SF
为了研究跌倒的危险因素，我们进行了为期一年的前瞻性调查，使用了336人的样本，至少75岁的人生活在社区。所有受试者都接受了详细的临床评估，包括精神状态、力量、反射、平衡和Galt的标准化测量;此外，我们还检查了他们家中的环境危害。福尔斯及其情况是在每两个月的电话中确定的。在一年的随访中，108名受试者（32%）至少摔倒过一次; 24%的摔倒者严重受伤，6%骨折。在线性逻辑模型中确定了福尔斯的诱发因素。镇静剂使用的校正比值比为28.3;认知障碍为5.0;下肢残疾为3.8;手掌反射为3.0;平衡和步态异常为1.9;足部问题为1.8;所有变量的95%置信区间下限均为1或以上。跌倒的风险随着危险因素的增加而线性增加，从没有危险因素的8%增加到有四个或更多危险因素的78%（P < 0.0001）。大约10%的福尔斯跌倒发生在急性疾病期间，5%发生在危险活动期间，44%发生在环境危害期间。我们的结论是，福尔斯之间的老年人生活在社区是常见的，一个简单的临床评估可以确定老年人谁是在最大的风险下降。
To study risk factors of falling, we conducted a one-year prospective investigation, using a sample of 336 persons at least 75 years of age who were living in the community. All subjects underwent detailed clinical evaluation, including standardized measures of mental status, strength, reflexes, balance, and galt; in addition, we inspected their homes for environmental hazards. Falls and their circumstances were identified during bimonthly telephone calls. During one year of follow-up, 108 subjects (32 percent) fell at least once; 24 percent of those who fell had serious injuries and 6 percent had fractures. Predisposing factors for falls were identified in linear-logistic models. The adjusted odds ratio for sedative use was 28.3; for cognitive impairment, 5.0; for disability of the lower extremities, 3.8; for palmomental reflex, 3.0; for abnormalities of balance and gait, 1.9; and for foot problems, 1.8; the lower bounds of the the 95 percent confidence intervals were 1 or more for all variables. The risk of falling increased linearly with the number of risk factors, from 8 percent with none to 78 percent with four or more risk factors (P < 0.0001). About 10 percent of the falls occurred during acute illness, 5 percent during hazardous activity, and 44 percent in the presence of environmental hazards. We conclude that falls among older persons living in the community are common and that a simple clinical assessment can identify the elder persons who are at the greatest risk of falling.