老年人跌倒时手持物体对头部撞击发生的影响：来自长期护理中实际跌倒的证据。
Effect of Holding Objects on the Occurrence of Head Impact in Falls by Older Adults: Evidence From Real-Life Falls in Long-Term Care.
机构信息
Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada.
Department of Sports Science and Physical Education, The Chinese University of Hong Kong, China.
出版信息
J Gerontol A Biol Sci Med Sci. 2021 Jul 13;76(8):1463-1470. doi: 10.1093/gerona/glaa168.
BACKGROUND
Falls cause approximately 80% of traumatic brain injuries in older adults, and nearly one third of falls by residents in long-term care (LTC) result in head impact. Holding objects during falls, such as mobility aids, may affect the ability of LTC residents to avoid head impact by arresting the fall with their upper limbs. We examined the prevalence of holding objects and their effect on risk for head impact during real-life falls in older adults living in LTC.
METHODS
We analyzed videos of 1105 real-life falls from standing height by 425 LTC residents, using a validated questionnaire to characterize the occurrence of head impact and whether the resident held objects during descent and impact. We classified objects as either "weight-bearing" (via contact to the fixed environment, eg, chairs and walkers) or "non-weight-bearing" (eg, cups) and tested their effect on odds for head impact with generalized estimating equations.
RESULTS
Residents held objects in more than 60% of falls. The odds for head impact were reduced for falls where weight-bearing objects were held or grasped during descent (odds ratio = 0.52; 95% confidence interval = 0.39-0.70) or maintained throughout the fall (odds ratio = 0.34; 95% confidence interval = 0.23-0.49). The most commonly held objects were chairs/wheelchairs (23% of cases), tables/counters (10% of cases), and walkers/rollators (22% of cases); all reduced the odds of head impact when held during descent. Holding non-weight-bearing objects did not affect the odds of head impact (odds ratio = 1.00; 95% confidence interval = 0.64-1.55).
CONCLUSION
Our results show that older adults in LTC use held, weight-bearing objects to reduce their risk for head impact during falls.
背景
跌倒导致老年人创伤性脑损伤的约 80%，近三分之一的长期护理（LTC）居民的跌倒导致头部撞击。在跌倒时抓住物体，如助行器，可能会影响 LTC 居民通过用其上肢阻止跌倒来避免头部撞击的能力。我们研究了在 LTC 居住的老年人实际跌倒中抓住物体的流行率及其对头部撞击风险的影响。
方法
我们使用经过验证的问卷分析了 425 名 LTC 居民从站立高度的 1105 次实际跌倒的视频，以描述头部撞击的发生情况以及居民在下降和撞击过程中是否抓住物体。我们将物体分为“承重”（通过与固定环境接触，例如椅子和助行器）和“非承重”（例如杯子），并用广义估计方程测试它们对头部撞击几率的影响。
结果
居民在超过 60%的跌倒中抓住物体。在下降过程中抓住承重物体或在整个下降过程中保持抓住承重物体的情况下，头部撞击的几率降低（比值比=0.52；95%置信区间=0.39-0.70）。最常抓住的物体是椅子/轮椅（23%的病例），桌子/柜台（10%的病例）和助行器/移动助步器（22%的病例）；所有这些物体在下降过程中均降低了头部撞击的几率。抓住非承重物体不会影响头部撞击的几率（比值比=1.00；95%置信区间=0.64-1.55）。
结论
我们的结果表明，LTC 中的老年人使用承重物体来降低跌倒时头部撞击的风险。
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