Cook Wendy L, Tomlinson George, Donaldson Meghan, Markowitz Samuel N, Naglie Gary, Sobolev Boris, Jassal Sarbjit V
Division of Geriatric Medicine, Faculty of Medicine, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
Clin J Am Soc Nephrol. 2006 Nov;1(6):1197-204. doi: 10.2215/CJN.01650506. Epub 2006 Aug 30.
Dialysis patients are increasingly older and more disabled. In community-dwelling seniors without kidney disease, falls commonly predict hospitalization, the onset of frailty, and the need for institutional care. Effective fall prevention strategies are available. On the basis of retrospective data, it was hypothesized that the fall rates of older (> or =65 yr) chronic outpatient hemodialysis (HD) patients would be higher than published rates for community-dwelling seniors (0.6 to 0.8 falls/patient-year). It also was hypothesized that risk factors for falls in dialysis outpatients would include polypharmacy, dialysis-related hypotension, cognitive impairment, and decreased functional status. Using a prospective cohort study design, HD patients who were > or =65 yr of age at a large academic dialysis unit were recruited. All study participants underwent baseline screening for fall risk factors. Patients were followed prospectively for a minimum of 1 yr. Falls were identified through biweekly patient interviews in the HD unit. A total of 162 patients (mean age 74.7 yr) were recruited; 57% were male. A total of 305 falls occurred in 76 (47%) patients over 190.5 person-years of follow-up (fall-incidence 1.60 falls/person-year). Injuries occurred in 19% of falls; 41 patients had multiple falls. Associated risk factors included age, comorbidity, mean predialysis systolic BP, and a history of falls. In the HD population, the fall risk is higher than in the general community, and fall-related morbidity is high. Better identification of HD patients who are at risk for falls and targeted fall intervention strategies are required.
透析患者的年龄越来越大，身体残疾情况也越来越多。在没有肾脏疾病的社区老年人中，跌倒通常预示着住院、虚弱的开始以及对机构护理的需求。有效的跌倒预防策略是可行的。基于回顾性数据，研究假设年龄较大（≥65岁）的慢性门诊血液透析（HD）患者的跌倒发生率会高于已公布的社区老年人跌倒发生率（0.6至0.8次跌倒/患者年）。还假设透析门诊患者跌倒的危险因素包括多种药物治疗、透析相关低血压、认知障碍和功能状态下降。采用前瞻性队列研究设计，招募了一家大型学术透析单位中年龄≥65岁的HD患者。所有研究参与者都接受了跌倒危险因素的基线筛查。对患者进行了至少1年的前瞻性随访。通过在HD单位每两周对患者进行一次访谈来确定跌倒情况。共招募了162名患者（平均年龄74.7岁）；57%为男性。在190.5人年的随访中，76名（47%）患者共发生了305次跌倒（跌倒发生率为1.60次跌倒/人年）。19%的跌倒导致了受伤；41名患者有多次跌倒。相关危险因素包括年龄、合并症、透析前平均收缩压和跌倒史。在HD人群中，跌倒风险高于普通社区，且与跌倒相关的发病率较高。需要更好地识别有跌倒风险的HD患者并制定有针对性的跌倒干预策略。
