HPC Healthcare, Inc., Temple Terrace, Florida, USA.
J Palliat Med. 2010 Nov;13(11):1353-63. doi: 10.1089/jpm.2010.0140. Epub 2010 Nov 1.
Falls can pose a serious threat to hospice patients receiving palliative care. Interventions to reduce falls have yielded minimal results among older patients. Falls among hospice patients provide a unique population from which a new approach to fall prevention may need to be established.
The aim is to devise a forecasting model with which to predict the probability of a patient fall and evaluate whether the model predicts patient falls better than existing measures.
Two hundred patients were randomly selected from one of the largest hospices in the United States. After patient admission, patient falls were followed-up via weekly calls until a fall, patient death, or hospice discharge occurred. Independent factors included demographic, functional status, environmental measures, symptoms, medications, attitudinal dispositions, and the use of an ambulatory aid.
Cognitively intact hospice patients who have a higher risk of falls are those who had a past history of a fall (p = 0.022), patients that are physically more functional as demonstrated by higher score on the Palliative Performance Scale (p = .039), patients with a greater "fear-of-losing-independence (p = 0.023)," those who try to "avoid asking for help (p = 0.005)," and those who "feel uneasy about asking for help (p = 0.05)." Patients who depend on ambulatory aids were less likely to fall (p=0.06). The forecasting model predicted patient falls correctly in 78% of the patients observed.
The current model predicted fall occurrence far better than the Morse Falls Scale and other functional status measures and may lead to a shift in fall prevention approaches among hospice patients.
跌倒可能对接受姑息治疗的临终关怀患者构成严重威胁。减少跌倒的干预措施对老年患者收效甚微。临终关怀患者的跌倒提供了一个独特的人群，可能需要建立一种新的预防跌倒方法。
旨在设计一个预测模型来预测患者跌倒的概率，并评估该模型是否比现有措施更好地预测患者跌倒。
从美国最大的临终关怀之一中随机选择了 200 名患者。在患者入院后，通过每周电话随访患者跌倒情况，直到发生跌倒、患者死亡或临终关怀出院。独立因素包括人口统计学、功能状态、环境措施、症状、药物、态度倾向以及使用助行器。
认知功能完整但有较高跌倒风险的临终关怀患者是那些有跌倒病史的患者（p=0.022）、表现出更高的姑息治疗表现量表评分的身体功能更好的患者（p=0.039）、“更害怕失去独立性”的患者（p=0.023）、试图“避免寻求帮助”的患者（p=0.005）和“感到难以寻求帮助”的患者（p=0.05）。依赖助行器的患者跌倒的可能性较小（p=0.06）。该预测模型正确预测了观察到的 78%的患者跌倒。
目前的模型预测跌倒发生的情况远远优于 Morse 跌倒量表和其他功能状态测量，可能会导致临终关怀患者预防跌倒方法的转变。
