Russell Melissa A, Hill Keith D, Blackberry Irene, Day Lesley L, Dharmage Shyamali C
Bachelor of Physiotherapy, National Ageing Research Institute, Poplar Road, Parkville, Victoria, Australia.
J Gerontol A Biol Sci Med Sci. 2006 Oct;61(10):1090-5. doi: 10.1093/gerona/61.10.1090.
There is currently no standard approach to falls risk assessment and management for older fallers presenting to the emergency department (ED) who are discharged directly home. Hence, this study was conducted to describe the prevalence of falls risk factors associated with older fallers presenting to the ED and to identify the factors associated with postdischarge decline in function in this group.
This cross-sectional study was performed with 300 community-dwelling individuals, aged 60 years or older, admitted to the ED following a fall, and discharged directly home. A home-based assessment after ED discharge was performed, which included the prevalence of falls risk factors, identification of functional decline, and objective measurements of balance, gait, depression, and falls efficacy.
Fall-related injuries were sustained by 91% (95% confidence interval [CI], 87.2%-94.0%) of participants presenting to the ED. The most common falls risk factors identified in the home assessment were polypharmacy (79.0%, 95% CI, 73.9%-83.5%), home hazards (76.0%, 95% CI, 70.8%-80.7%), decreased balance (61.3%, 95% CI, 55.6%-66.9%), and arthritis (61.3%, 95% CI, 55.6%-66.9%). A decline in function was reported by 35% of participants (95% CI, 29.6%-40.7%). Sustaining a fracture, functional independence before the fall, being female, depression, and slower Timed Up and Go (TUG) scores were associated with a decline in function (p <.05).
Older fallers discharged directly from the ED have a high prevalence of falls risk factors and are at risk of functional decline.
对于直接出院回家的急诊科老年跌倒患者，目前尚无标准的跌倒风险评估和管理方法。因此，本研究旨在描述急诊科老年跌倒患者中与跌倒风险因素相关的患病率，并确定该群体出院后功能下降的相关因素。
本横断面研究纳入了300名60岁及以上的社区居住个体，这些个体因跌倒入院急诊科后直接出院回家。在急诊科出院后进行了基于家庭的评估，包括跌倒风险因素的患病率、功能下降的识别以及平衡、步态、抑郁和跌倒效能的客观测量。
到急诊科就诊的参与者中有91%（95%置信区间[CI]，87.2%-94.0%）遭受了与跌倒相关的损伤。在家庭评估中确定的最常见的跌倒风险因素是多重用药（79.0%，95%CI，73.9%-83.5%）、家庭危险因素（76.0%，95%CI，70.8%-80.7%）、平衡能力下降（61.3%，95%CI，55.6%-66.9%）和关节炎（61.3%，95%CI，55.6%-66.9%）。35%的参与者报告功能下降（95%CI，29.6%-40.7%）。发生骨折、跌倒前的功能独立性、女性、抑郁以及计时起立行走测试（TUG）得分较慢与功能下降相关（p<.05）。
从急诊科直接出院的老年跌倒患者跌倒风险因素的患病率较高，且有功能下降的风险。
