Identification of Fall Risk Factors in Older Adult Emergency Department Patients
Identification of Fall Risk Factors in Older Adult Emergency Department Patients
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DOI：
10.1111/j.1553-2712.2009.00351.x
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发表时间：
2009-03-01
影响因子：
4.4
通讯作者：
Coben, Jeffrey H.
中科院分区：
文献类型：
--
作者：
Carpenter, Christopher R.;Scheatzle, Mark D.;Coben, Jeffrey H.
跌倒是老年人受伤的一个日益常见的原因。识别老年患者跌倒的危险因素可能允许有效利用稀缺的预防资源。本研究的目的是确定与社区居住的急诊科（ED）出院的老年人6个月跌倒风险增加相关的独立危险因素。这是一项前瞻性观察性研究，选取了到城市教学医院急诊科就诊的不需要住院的非机构老年人作为样本。进行访谈以确定先前在非ed人群中描述的跌倒危险因素的存在。通过明信片或电话联系对受试者进行为期6个月的月度随访，以确定随后的跌倒情况。采用单因素和Cox回归分析确定危险因素与6个月跌倒发生率的关系。共有263例患者完成了调查，161例（61%）完成了整个6个月的随访。在263名在校生中，39%的人报告在前一年摔倒过，其中15%的人摔倒过一次以上，22%的人摔伤过。在完成6个月随访的患者中，14%报告至少有一次跌倒。在6个月的随访中，Cox回归分析确定了与跌倒相关的四个因素：未愈合的足疮（风险比[HR] = 3.71, 95%可信区间[CI] = 1.73至7.95），先前的跌倒史（风险比[HR] = 2.62, 95% CI = 1.32至5.18），无法剪自己的脚趾甲（风险比= 2.04,95% CI = 1.04至4.01），以及自我报告的抑郁症（风险比= 1.72,95% CI = 0.83至3.55）。在社区居住的老年ED患者中，因非跌倒相关的主诉而被评估的跌倒、复发性跌倒和伤害性跌倒的发生频率至少与先前描述的门诊队列相同。无法愈合的足疮、自我报告的抑郁、不剪自己的脚趾甲以及以前的跌倒都与急诊科出院后的跌倒有关。
Falls represent an increasingly frequent source of injury among older adults. Identification of fall risk factors in geriatric patients may permit the effective utilization of scarce preventative resources. The objective of this study was to identify independent risk factors associated with an increased 6-month fall risk in community-dwelling older adults discharged from the emergency department (ED).This was a prospective observational study with a convenience sampling of noninstitutionalized elders presenting to an urban teaching hospital ED who did not require hospital admission. Interviews were conducted to determine the presence of fall risk factors previously described in non-ED populations. Subjects were followed monthly for 6 months through postcard or telephone contact to identify subsequent falls. Univariate and Cox regression analysis were used to determine the association of risk factors with 6-month fall incidence.A total of 263 patients completed the survey, and 161 (61%) completed the entire 6 months of follow-up. Among the 263 enrolled, 39% reported a fall in the preceding year, including 15% with more than one fall and 22% with injurious falls. Among those completing the 6 months of follow-up, 14% reported at least one fall. Cox regression analysis identified four factors associated with falls during the 6-month follow-up: nonhealing foot sores (hazard ratio [HR] = 3.71, 95% confidence interval [CI] = 1.73 to 7.95), a prior fall history (HR = 2.62, 95% CI = 1.32 to 5.18), inability to cut one's own toenails (HR = 2.04, 95% CI = 1.04 to 4.01), and self-reported depression (HR = 1.72, 95% CI = 0.83 to 3.55).Falls, recurrent falls, and injurious falls in community-dwelling elder ED patients being evaluated for non-fall-related complaints occur at least as frequently as in previously described outpatient cohorts. Nonhealing foot sores, self-reported depression, not clipping one's own toenails, and previous falls are all associated with falls after ED discharge.