Nevitt M C, Cummings S R, Hudes E S
Division of Clinical Epidemiology, University of California, San Francisco.
J Gerontol. 1991 Sep;46(5):M164-70. doi: 10.1093/geronj/46.5.m164.
We conducted a prospective study of the consequences of falls in 325 elderly community-dwelling persons, all of whom had fallen in the previous year. We contacted subjects every week for one year to ascertain falls and to determine the circumstances and consequences of falls. Only 6% of 539 falls resulted in a major injury (fracture, dislocation, or laceration requiring suture), but over half (55%) resulted in minor soft tissue injury. One in ten falls left the faller unable to get up for at least 5 minutes, and one in four falls caused subjects to limit their activities. The risk of injury per fall was about the same regardless of the number of falls a person had during follow-up. The risk of major injury was increased (age- and sex-adjusted odds ratio: 5.9, 95% confidence interval: 2.3-14.9) in falls associated with loss of consciousness compared to nonsyncopal falls. In multivariate analyses of nonsyncopal falls, the risk of major injury per fall was higher in persons having a previous fall with fracture (6.7; 2.1-21.5), a slower Trail Making B time (1.9; 1.1-3.2), and in Whites (18.4; 7.5-44.6). The risk that a nonsyncopal fall would result in minor injury (versus no injury) was increased in persons with a slower hand reaction time (1.8; 1.0-3.2) decreased grip strength (1.5; 1.0-2.3), in Whites (2.0; 1.0-3.7), in falls while using stairs and steps (2.2; 1.0-5.0), and turning around or reaching (3.5; 1.7-7.3). Our findings suggest that neuromuscular and cognitive impairment, as well as the circumstances of falls, affect the risk of injury when a fall occurs.
我们对325名居住在社区的老年人跌倒的后果进行了一项前瞻性研究，所有这些老年人在前一年都曾跌倒过。我们连续一年每周与受试者联系，以确定跌倒情况，并确定跌倒的情形及后果。在539次跌倒中，只有6%导致了重伤（骨折、脱位或需要缝合的撕裂伤），但超过一半（55%）导致了轻度软组织损伤。十分之一的跌倒使跌倒者至少5分钟无法起身，四分之一的跌倒导致受试者限制其活动。无论一个人在随访期间跌倒的次数多少，每次跌倒受伤的风险大致相同。与非晕厥性跌倒相比，与意识丧失相关的跌倒导致重伤的风险增加（年龄和性别调整后的优势比：5.9，95%置信区间：2.3 - 14.9）。在对非晕厥性跌倒的多变量分析中，既往有骨折跌倒史的人（6.7；2.1 - 21.5）、连线测验B时间较慢的人（1.9；1.1 - 3.2）以及白人（18.4；7.5 - 44.6）每次跌倒导致重伤的风险更高。手部反应时间较慢的人（1.8；1.0 - 3.2）、握力下降的人（1.5；1.0 - 2.3）、白人（2.0；1.0 - 3.7）、在使用楼梯和台阶时跌倒的人（2.2；1.0 - 5.0）以及转身或伸手时跌倒的人（3.5；1.7 - 7.3），非晕厥性跌倒导致轻伤（而非无损伤）的风险增加。我们的研究结果表明，神经肌肉和认知障碍以及跌倒情形，在跌倒发生时会影响受伤风险。
