Activity restriction vs. self-direction: hospitalised older adults' response to fear of falling
Activity restriction vs. self-direction: hospitalised older adults' response to fear of falling
复制标题
DOI：
10.1111/opn.12015
复制
发表时间：
2014-03-01
影响因子：
2.2
通讯作者：
Shuluk, Joseph
中科院分区：
文献类型：
--
作者：
Boltz, Marie;Resnick, Barbara;Shuluk, Joseph
背景。功能下降是住院老年人的常见并发症，与活动能力和体力活动不足有关。对跌倒的恐惧可能导致行动和身体活动受限，以及身体功能丧失。了解这种关系以及影响因素，可以为开发安全的、促进功能的干预措施提供信息。采用图表提取、观察和访谈相结合的定量和定性方法。(i)相关性和方差分析方法；（二）内容和专题分析；（iii）定量和定性数据的收敛性、互补性和不一致性的评估。抑郁的老年人更有可能描述害怕跌倒（r = 0.47, P = 0.002）。从入院到出院，对跌倒的恐惧与身体功能的丧失有关（F = 7.6, P = 0.009）。参与者对摔倒恐惧的反应是活动限制vs自我引导。与会者描述了在制定活动限制的替代方案时应考虑的社会-生态框架组织的以下因素：个人、人际、环境和政策。对摔倒的恐惧在限制身体活动和功能方面起着重要作用。通过促进自我指导和功能恢复，多因素方法可能为活动限制提供一种可行的替代方法。对实践的启示。预防跌倒的干预措施和促进功能活动的活动是理想的，同时要注意身体和社会环境。预防医院获得性残疾可能需要围绕安全的组织价值观发生转变，从单纯的保护方式转变为反映强调独立和自我指导的支持理念。这种模式的转变将表明，不仅要重视避免跌倒，而且要重视功能的保存和恢复。的目标。描述住院老年人对跌倒的恐惧及其与患者特征和身体功能的关系，并探讨患者对相关因素的看法。
Background. Functional decline is a common complication in hospitalised older adults, associated with low mobility and physical activity. Fear of falling may contribute to limited mobility and physical activity, and loss of physical function. An understanding of this relationship, as well as contributing factors, may inform the development of safe, function-promoting interventions.Design. combined quantitative and qualitative approach using chart extraction, observation and interviews of older adults.Methods. (i) correlations and analysis of variance methods; (ii) content and thematic analysis; and (iii) evaluation of convergence, complementarity and dissonance of quantitative and qualitative data.Results. Depressed older persons were more likely to describe fear of falling (r = 0.47, P = 0.002). Fear of falling was associated with the loss of physical function from admission to discharge (F = 7.6, P = 0.009). The participant response to fear of falling was activity restriction vs. self-direction. Participants described the following factors, organised by social-ecological framework, to be considered when developing alternatives to activity restriction: intrapersonal, interpersonal, environmental and policy.Conclusion. Fear of falling plays a significant role in restricting physical activity and function. A multifactorial approach may provide a viable alternative to activity restriction, by facilitating self-direction and functional recovery.Implications for practice. Interventions to prevent falls and activities to promote functional mobility are ideally developed in tandem, with attention paid to the physical and social environment. Preventing hospital-acquired disability may require a shift in organisational values around safety, from a soley protective approach to one that reflects an enabling philosophy emphasising independence and self-direction. Such a paradigm shift would demonstrate a valuing not only of the absence of falls but also the preservation and restoration of function. Aim. To describe fear of falling in hospitalised older adults and its relationship with patient characteristics and physical function and explore patient views of associated factors.