Buchner D M, Larson E B
JAMA. 1987 Mar 20;257(11):1492-5.
The prevention of fall-related injuries in patients with Alzheimer-type dementia (ATD) is hampered by an incomplete understanding of their causes. We studied falls and fractures in 157 ATD patients, including 117 with three-year follow-up. Initially all but one patient could walk; 31% reported falls. During follow-up, 50% either fell or became unable to walk. The fracture rate during follow-up (69/1000/y) was more than three times the age- and sex-adjusted fracture rate in the general population. Features of both ATD and comorbid conditions contributed to the risk of falls and fractures. In particular, patients who experienced toxic reactions to drugs on entry into the study were more likely to report they had fallen prior to entry (odds ratio, 4.9; 95% confidence interval, 1.78 to 13.3), and patients who wandered were more likely to sustain fractures (odds ratio, 3.6; 95% confidence interval, 1.25 to 10.4) during the follow-up period, including hip fractures for which the odds ratio of 6.9 (95% confidence interval, 1.66 to 28.6) was unexpectedly high. Preventive measures may be possible, including controlling wandering, avoiding toxic reactions to drugs, and treating comorbid illnesses.
对阿尔茨海默型痴呆（ATD）患者跌倒相关损伤的预防因对其病因的不完全了解而受阻。我们研究了157例ATD患者的跌倒和骨折情况，其中117例进行了三年随访。最初，除1例患者外所有患者均可行走；31%的患者报告有跌倒。在随访期间，50%的患者要么跌倒，要么无法行走。随访期间的骨折发生率（69/1000/年）是一般人群年龄和性别调整后骨折发生率的三倍多。ATD的特征和共病情况均增加了跌倒和骨折风险。特别是，在研究开始时出现药物毒性反应的患者更有可能报告在入组前曾跌倒（优势比，4.9；95%置信区间，1.78至13.3），在随访期间，游荡的患者更有可能发生骨折（优势比，3.6；95%置信区间，1.25至10.4），包括髋部骨折，其优势比为6.9（95%置信区间，1.66至28.6），出乎意料地高。预防措施可能可行，包括控制游荡、避免药物毒性反应以及治疗共病。
