Bueno-Cavanillas A, Padilla-Ruiz F, Jiménez-Moleón J J, Peinado-Alonso C A, Gálvez-Vargas R
Department of Preventive Medicine and Public Health, University of Granada, Spain.
Eur J Epidemiol. 2000;16(9):849-59. doi: 10.1023/a:1007636531965.
The aim of this prospective cohort study was to identify the risk factors involved in falls in 190 elderly residents of two geriatric centres in Granada (Andalusia, Spain). Because different types of falls may be associated with different factors, falls were classified according to the precipitating cause, either extrinsic or intrinsic. The incidence density and the ratios for crude and adjusted density were calculated. Cox proportional risk analysis was used to calculate adjusted incidence density ratios. Of the 121 falls identified, 63 (52.1%) had a extrinsic precipitating cause, 43 (35.5%) had an intrinsic precipitating cause, and no precipitating cause was determined in 15 falls. The rate of falls with an extrinsic precipitating cause was 0.39 per person per year, while falls with an intrinsic precipitating cause showed a frequency of 0.27 per person per year. For falls with an extrinsic precipitating cause, the most significant risk factors were: age, diabetes mellitus, a history of falling, and treatment with neuroleptics or oral bronchodilators. The number of illnesses acted as a protective factor. For falls with an intrinsic precipitating cause, the independent risk factors were: age, diabetes, dementia, alterations of gait and balance, previous falls, and treatment with digitalins, neuroleptics or antidepressants. These results suggest that the susceptibility to a fall with an intrinsic precipitating cause is easier to identify and has a greater potential for being controlled.
这项前瞻性队列研究的目的是确定西班牙安达卢西亚格拉纳达市两家老年护理中心190名老年居民跌倒的相关危险因素。由于不同类型的跌倒可能与不同因素相关，因此根据诱发原因（外在或内在）对跌倒进行分类。计算了发病密度以及粗密度和调整密度的比值。采用Cox比例风险分析来计算调整后的发病密度比值。在确定的121次跌倒中，63次（52.1%）有外在诱发原因，43次（35.5%）有内在诱发原因，15次跌倒未确定诱发原因。有外在诱发原因的跌倒发生率为每人每年0.39次，而有内在诱发原因的跌倒发生率为每人每年0.27次。对于有外在诱发原因的跌倒，最显著的危险因素是：年龄、糖尿病、跌倒史以及使用抗精神病药物或口服支气管扩张剂治疗。疾病数量起到保护作用。对于有内在诱发原因的跌倒，独立危险因素是：年龄、糖尿病、痴呆、步态和平衡改变、既往跌倒以及使用洋地黄制剂、抗精神病药物或抗抑郁药物治疗。这些结果表明，有内在诱发原因的跌倒易感性更容易识别，且有更大的控制潜力。
