Department of Medicine, Faculty of Medicine, University of Ruhuna, Matara, Sri Lanka.
Department of Nursing, Faculty of Allied Health Sciences, University of Ruhuna, Matara, Sri Lanka.
BMC Geriatr. 2024 Oct 23;24(1):864. doi: 10.1186/s12877-024-05477-1.
Falls take a high priority among the prevalent medical conditions in old age. Despite this, a history of falls or the risk of future falls is not routinely assessed or properly managed in medical clinics in Sri Lanka. This study was done to evaluate the prevalence and factors associated with falls and recurrent falls among older adults attending medical clinics in four selected tertiary care centres in the country.
A cross-sectional study was carried out at four centres (Teaching Hospital Karapitiya, Colombo South Teaching Hospital, Colombo North Teaching Hospital and University Hospital-Kotelawala Defence University) with 704 older adults, aged 65 years and above, attending medical clinics for more than six consecutive months. Information related to falls and possible associated factors (socio-demographic, behavioural, environmental and biological) were collected using an interviewer-administered questionnaire.
The Mean (SD) age of the participants was 72.5(5.5) years and 58.7% were females. Of the 704 total sample, 220 (31.3%, 95% CI 28-35%) participants experienced at least one fall after the age of 65, and 12.8% (95% CI 10-15%) (n = 90) experienced recurrent falls (two or more falls within the last 12 months). Falls were associated with gender, level of education, marital status, and physical dependence (p < 0.01). For those who had at least one fall, multiple logistic regression (MLR) revealed being single (p = 0.03, OR = 2.12, 95% CI; 1.052-4.304), being widowed/divorced/separated (p = 0.03, OR = 1.47, 95% CI; 1.039-2.093) compared to living with a spouse, presence of moderate (p = 0.007, OR = 1.72, 95% CI; 1.160-2.577) and severe (p = 0.001, OR = 2.98, 95% CI; 1.563-5.688) physical dependency compared to mild physical dependency as risk factors for falls. Having secondary education (p = 0.01, OR = 0.55, 0.350-0.876) was a protective factor for falls. For those with recurrent falls, MLR showed moderate physical dependency (p = 0.001, OR = 2.34, 95% CI; 1.442-3.821) compared to slight physical dependency as a risk factor.
Approximately one-third of the older adults attending medical clinics had experienced at least a single fall, and one-eighth have had recurrent falls, which were mostly unrecorded and not clinically assessed. Physical dependency was the major contributing factor to falls and recurrent falls. Falls assessment should be included in the routine clinical assessment of older adults attending outdoor medical clinics. Health professionals should be educated to detect and assess those at risk of falling and take appropriate measures to prevent or minimize falls.
在老年人常见的医疗状况中，跌倒占据很高的优先级。尽管如此，在斯里兰卡的医疗诊所中，通常不会对跌倒史或未来跌倒的风险进行评估或妥善管理。本研究旨在评估在该国四个选定的三级保健中心就诊的老年患者中跌倒的发生率和与跌倒相关的因素以及复发性跌倒。
在四个中心（卡拉皮蒂亚教学医院、科伦坡南部教学医院、科伦坡北部教学医院和大学医院-国防大学）进行了一项横断面研究，共有 704 名年龄在 65 岁及以上、在医疗诊所就诊时间超过 6 个月的老年人参与。使用访谈者管理的问卷收集与跌倒和可能相关的因素（社会人口统计学、行为、环境和生物学）相关的信息。
参与者的平均（SD）年龄为 72.5（5.5）岁，58.7%为女性。在 704 名总样本中，220 名（31.3%，95%CI 28-35%）参与者在 65 岁后至少经历过一次跌倒，12.8%（95%CI 10-15%）（n=90）经历过复发性跌倒（在过去 12 个月内发生两次或两次以上跌倒）。跌倒与性别、教育程度、婚姻状况和身体依赖有关（p<0.01）。对于那些至少经历过一次跌倒的人，多变量逻辑回归（MLR）显示单身（p=0.03，OR=2.12，95%CI；1.052-4.304）、丧偶/离婚/分居（p=0.03，OR=1.47，95%CI；1.039-2.093）与与配偶同住相比，是跌倒的风险因素，中度（p=0.007，OR=1.72，95%CI；1.160-2.577）和重度（p=0.001，OR=2.98，95%CI；1.563-5.688）身体依赖与轻度身体依赖相比，身体依赖是跌倒的风险因素。接受过中等教育（p=0.01，OR=0.55，0.350-0.876）是跌倒的保护因素。对于复发性跌倒者，MLR 显示中度身体依赖（p=0.001，OR=2.34，95%CI；1.442-3.821）与轻度身体依赖相比是风险因素。
大约三分之一在医疗诊所就诊的老年人至少经历过一次跌倒，八分之一的老年人经历过复发性跌倒，而这些跌倒大多未被记录且未进行临床评估。身体依赖是跌倒和复发性跌倒的主要原因。跌倒评估应纳入在户外医疗诊所就诊的老年人的常规临床评估中。应教育卫生专业人员识别和评估有跌倒风险的患者，并采取适当措施预防或尽量减少跌倒。
