Kings Health Partners, Kings College Hospital, London, UK.
J Am Med Dir Assoc. 2012 Jul;13(6):535-40. doi: 10.1016/j.jamda.2012.03.009. Epub 2012 May 5.
To better understand fall risk factors in older adults with cognitive impairment living in residential care.
A prospective observational cohort study.
Residential care homes in South London, UK.
Residents older than 60, with cognitive impairment who had a life expectancy of at least 6 months and were not bedbound or recently discharged from hospital.
Baseline assessments were undertaken in domains of demographics, medical history, medication use, behavior, affect, gait, balance, sensorimotor performance and neuropsychological function. Participants were followed for 6 months for falls using care home reporting systems.
A total of 109 participants completed baseline assessment and had adequate falls follow-up. Fallers took more medications, were more likely to be taking antidepressants, had more functional impairment, poorer balance and gait, were more impulsive and anxious, exhibited more dementia-related behaviors, and performed worse on cognitive tests involving attention and orientation, memory, and fluency. Logistic regression analysis identified 4 significant and independent predictors of falls: poor attention and orientation, increased postural sway with eyes closed, anxiety, and antidepressant use. The AUC for this model was 0.84 (95% CI 0.76-0.91).
This study identified important risk factors for falls potentially amenable to intervention in older people with cognitive impairment living in residential care. This information may be useful in designing effective approaches to fall prevention in this high-risk population.
更好地了解居住在养老院的认知障碍老年人的跌倒风险因素。
前瞻性观察队列研究。
英国伦敦南部的养老院。
年龄在 60 岁以上、有认知障碍、预期寿命至少为 6 个月、非卧床不起或最近未出院的居民。
在人口统计学、病史、用药情况、行为、情绪、步态、平衡、感觉运动表现和神经心理学功能等方面进行基线评估。使用养老院报告系统对参与者进行了 6 个月的跌倒随访。
共有 109 名参与者完成了基线评估并进行了充分的跌倒随访。跌倒者服用的药物更多，更有可能服用抗抑郁药，功能障碍更严重，平衡和步态更差，更冲动和焦虑，表现出更多与痴呆相关的行为，并且在涉及注意力和定向、记忆和流畅性的认知测试中表现更差。逻辑回归分析确定了 4 个与跌倒显著相关且独立的预测因素：注意力和定向差、闭眼时姿势摆动增加、焦虑和使用抗抑郁药。该模型的 AUC 为 0.84（95%CI 0.76-0.91）。
本研究确定了居住在养老院的认知障碍老年人跌倒的重要风险因素，这些因素可能适合干预。这些信息可能有助于为这一高风险人群设计有效的跌倒预防方法。
