Evaluation of the fall risk assessment tool in the institutionalized elderly

目的：我们在住院老人中对跌倒风险评估工具进行了两年的评估。在第一年，我们修改了我们开发的跌倒风险评估工具，并对两个机构新入院的440名老年患者进行了测试。在第二年，我们分析了结果，并确定了护士直觉的依据。此外，我们确定的触发因素可能与患者的跌倒事件有关。方法1)研究期间，研究对象为454名老年患者，2001年为1256名，分别住在综合医院、长期护理机构、老年保健服务机构和康复病房。2)在入院、搬家后的几天内和每个月的月初对被试进行评估。结果1.修订后的评估工具Biside Trigger的平均得分为3.2±2.6。以4为界值时，敏感性为67.6%，特异性为75.0%。相对危险度最高的是护士的直觉(RR：7.7)，其次是轮椅使用者的转移能力(RR：3.8)和跌倒史(RR：3.4)。护士直觉的依据主要是身体平衡和转移能力不稳定，占60%~70%。调整后的优势比用多元Logistic回归得到。只有跌倒史(OD：3.46)有统计学意义。在三个月的时间里，两个机构的730名老年患者中有41人跌倒，相对风险最高的是跌倒病史(RR：9.2)。在护士的直觉、转移能力和触发方面，无跌倒病史的跌倒患者的相对风险大于3。同样，在康复单元中相对风险最高的是触发物(RR：3.6)，提示触发物可能是跌倒的危险因素。简而言之，修改后的跌倒风险评估工具可以根据FALS的历史进行划分，并根据风险级别进行分数分配，从而使其生效。

<Purpose>We evaluated the fall risk assessment tool in the institutionalized elderly for two years. In the first year, we modified the fall risk assessment tool that we developed and tested it to 440 elderly patients who were newly admitted in two institutions. In the second year, we analyzed results and identified grounds of the nurses' intuition. In addition, we identified triggers could relate to fall occurrences on patients.<Methods>1)The number of subjects was 454 elderly patients in 2000 and was 1256 ones in 2001, staying in general hospitals, long-term-care facilities, geriatric health services facilities, and a rehabilitation unit during the research projects. 2)Subjects were assessed on the modified assessment tool within a few days from admission and moving and in the beginning of every month.<Results>1. The average score of the modified assessment tool, biside trigger, was 3.2±2.6. The sensitivity was 67.6 %, and the specificity was 75.0 % on the cutoff point of 4. The highest relative risk was nurses' intuition (RR :7.7), followed by wheel chair users on the transfer abilities (RR : 3.8), and history of falls (RR : 3.4). The grounds of nurse's intuition were mainly unstable body balance and transfer ability, totally 60-70 %. Adjusted odds ratios were obtained using multiple logistic regression. Only history of falls (OD :3.46) reached statistical significance.2. Fallers were 41 out of 730 elederly patients in two institutions during three-months period, and the highest relative risk was history of falls (RR :9.2). The relative risk of fallers without history of falls was more than 3 in nurses' intuition, transfer abilities, and trigger. In the same way, the highest relative risk in the rehabilitation unit was trigger (RR :3.6), indicating trigger could be fall risk factor. In short, the modified fall risk assessment tool can be divided by according to history of fals and can be distributed of scores by according to risk level, which can become effectie.