Injurious falls in nonambulatory nursing home residents: A comparative study of circumstances, incidence, and risk factors
Injurious falls in nonambulatory nursing home residents: A comparative study of circumstances, incidence, and risk factors
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DOI：
10.1111/j.1532-5415.1996.tb00913.x
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发表时间：
1996-03-01
影响因子：
6.3
通讯作者：
Ray, WA
中科院分区：
文献类型：
--
作者：
Thapa, PB;Brockman, KG;Ray, WA
目的：目的：比较非卧床疗养院与非卧床疗养院的住院患者发生严重损伤的福尔斯的情况、发生率和危险因素。设计：前瞻性队列研究，随访1年。共有1228名居民，65岁或以上，其中725（59%）是卧床和503（41%）是ambulation.MEASUREMENTS：基线数据获得潜在危险因素的伤害性福尔斯。这些因素包括人口统计学特征、精神和身体功能、视力、听力、失禁以及机械束缚和精神药物的使用。数据来自直接居民评估、护理提供者访谈和疗养院最小数据集（MDS）（在居民样本中验证）。有111例首次福尔斯跌倒导致严重受伤（头部受伤，意识改变，骨折，关节脱位或扭伤，或缝合撕裂），接受了治疗（住院，急诊室就诊，医生就诊，或现场放射学检查），从设施事故报告和疗养院charts.RESULTS确定：卧床居民有精神和身体损害的患病率大幅上升。卧床患者损伤性福尔斯跌倒的情况（n = 39例福尔斯）和非卧床（n = 72福尔斯）居民不同;前一组的人更有可能涉及设备，（87%对45%，P < .0001），发生在坐着或转移过程中（82%对21%，P < .0001），以及从椅子/床水平（54%对6%，P < .0001）。不能走动的居民中伤害性福尔斯的发生率（6.7/100人年）不到走动居民的一半（17.0/100人年，P <0.0001）。在控制其他因素后，最高风险的卧床居民是那些不卧床和有能力独立转移的人（发病密度比（IDR）= 2.92，95%CI = 1.07-7.99）;处于最高风险的门诊居民是精神药物的基线使用者（IDR = 2.49，95%CI = 1.43-4.33）。结论：在研究队列中，卧床居民有35%的伤害性福尔斯。由于这些事件的情况和风险因素与非卧床住院患者有很大不同，因此可能需要对这一群体采取单独的预防策略。这些数据表明，提高转移和设备的安全性是干预的适当目标。
OBJECTIVE: To determine the circumstances of, incidence of, and risk factors for falls resulting in serious injuries in nonambulatory nursing home residents compared with those for ambulatory residents.DESIGN: Prospective cohort study with 1-year follow-upSETTING: Twelve community nursing homes in Tennessee.SUBJECTS: A total of 1228 residents, 65 years of age or older, of whom 725 (59%) were nonambulatory and 503 (41%) were ambulatory.MEASUREMENTS: Baseline data were obtained for potential risk factors for injurious falls. These included demographic characteristics, mental and physical function, vision, hearing, incontinence, and use of mechanical restraints and psychotropic drugs. Data were obtained from direct resident assessment, care provider interview, and the nursing home Minimum Data Set (MDS) (validated in a sample of residents).OUTCOME: There were 111 first falls resulting in serious injury (head injury with altered consciousness, fracture, joint dislocation or sprain, or sutured laceration) that received medical treatment (hospitalization, emergency room visit, physician visit, or on-site radiological examination), ascertained from facility incident reports and nursing home charts.RESULTS: Nonambulatory residents had a substantially greater prevalence of mental and physical impairment. Circumstances of injurious falls in nonambulatory (n = 39 falls) and ambulatory (n = 72 falls) residents differed; those in the former group were more likely to involve equipment (87% vs 45%, P < .0001), occur while seated or during transferring (82% vs 21%, P < .0001), and from a chair/bed level (54% vs 6%, P < .0001). The incidence of injurious falls in nonambulatory residents (6.7 per 100 person-years) was less than half that in ambulatory residents (17.0 per 100 person-years, P < .0001). After controlling for other factors, the nonambulatory residents at highest risk were those not bed-bound and with capacity for independent transfer (incidence density ratio (IDR) = 2.92, 95% CI = 1.07-7.99); the ambulatory residents at highest risk were baseline users of psychotropic drugs (IDR = 2.49, 95% CI = 1.43-4.33).CONCLUSIONS: In the study cohort, nonambulatory residents had 35% of injurious falls. Because the circumstances and risk factors of these events were substantially different from those for ambulatory residents, separate prevention strategies may be needed for this group. These data suggest that increasing the safety of transferring and of equipment are appropriate targets for interventions.