Vassallo Michael, Mallela Santhosh Kumar, Williams Andrew, Kwan Joseph, Allen Steve, Sharma Jagdish C
Royal Bournemouth Hospital, Bournemouth, UK.
Geriatr Gerontol Int. 2009 Mar;9(1):41-6. doi: 10.1111/j.1447-0594.2008.00506.x.
Confusion and cognitive impairment, are risk factors for falls in hospital. Evidence for reducing falls in cognitively-impaired patients is limited and to date no intervention has consistently been shown to reduce falls in this group of patients. We explored characteristics associated with falls in cognitively-impaired patients in a rehabilitation setting.
In a prospective observational study, 825 consecutive patients were studied. Patient characteristics were assessed on admission. Factors predisposing to falls in cognitively-impaired patients were identified.
Cognitively-impaired patients were more likely to be fallers or recurrent fallers and more likely to sustain an injury than cognitively intact patients. They had a higher incidence of nursing home discharges and a significantly higher mortality. Logistic regression analysis showed that an unsafe gait (P < 0.001; 95% confidence interval, 0.13-0.57) was the only independent risk factor for falls in this group of patients. There was a cumulative higher risk of falling associated with an unsafe gait demonstrable throughout the patients' stay.
Unsafe gait was the only significant independent risk factor for falls among cognitively-impaired patients in a rehabilitation environment. Interventions that improve gait patterns or that enhance safety for patients with abnormal gait are required if fall reduction in this group of patients is to be achieved.
意识模糊和认知障碍是住院患者跌倒的风险因素。降低认知障碍患者跌倒风险的证据有限，迄今为止，尚无干预措施能始终如一地减少这类患者的跌倒情况。我们探讨了康复环境中认知障碍患者跌倒的相关特征。
在一项前瞻性观察研究中，对825例连续患者进行了研究。入院时评估患者特征。确定认知障碍患者跌倒的易感因素。
与认知功能正常的患者相比，认知障碍患者更有可能跌倒或反复跌倒，且更有可能受伤。他们从养老院出院的发生率更高，死亡率也显著更高。逻辑回归分析显示，不安全步态（P<0.001；95%置信区间，0.13 - 0.57）是该组患者跌倒的唯一独立危险因素。在患者住院期间，不安全步态与跌倒风险的累积升高相关。
在康复环境中，不安全步态是认知障碍患者跌倒的唯一重要独立危险因素。若要减少这类患者的跌倒情况，需要采取改善步态模式或提高步态异常患者安全性的干预措施。
