新加坡社区老年居民跌倒的流行病学研究

Epidemiology of falls among the elderly community dwellers in Singapore.

作者信息

Chan K M, Pang W S, Ee C H, Ding Y Y, Choo P

机构信息

Alexandra Geriatric Centre, Alexandra Hospital, Singapore.

出版信息

Singapore Med J. 1997 Oct;38(10):427-31.

PMID:9529954

Abstract

AIM

Falling is a serious medical problem for elderly persons. This study was done to look at prevalence and risk factors for falls in community dwelling elderly in Singapore.

METHOD

A random sample of 3,000 persons aged 60 years and above was chosen from a database based on the 1990 population census. Letters were sent out to 2,582 subjects who had local and complete addresses. In the letter, they were informed about the purpose of the survey, and invited to participate in a questionnaire and clinical health screening at an appointed date at a polyclinic. Participants were reminded the day before their appointment by telephone, and a new appointment could be given at the subject's convenience.

RESULTS

We found a prevalence rate of falls of 17.2%. Two-thirds of these had single falls, while one-third had recurrent falls, defined as having more than one fall within the previous one year. The following factors were found to be significantly associated with increase falling in the elderly: age > or = 75 years (O.R. = 1.82, 95% C.I. 0.95-3.50), female sex (O.R. = 2.5, 95% C.I. 1.40-4.48), Malay race (O.R. = 2.66, 95% C.I. 1.21-5.86), poor vision (O.R. = 1.7, 95% C.I. 0.99-2.90), Barthel's score of less than 20 (O.R. = 1.76, 95% C.I. 0.94-3.28), those taking 2 or more drugs daily (O.R. = 2.1, 95% C.I. 1.22-3.72) and the presence of hypertension (O.R. = 1.78, 95% C.I. 1.06-3.01). Fall rate is also twice as high in women as in men. At the same time, we found that women in the group we studied also tend to exercise less than the men. Fallers also had significantly more mobility and activities of daily living (ADL) disabilities (reflected by a lower Barthel's score) and this is consistent with other results. The only factor that reduced the risk of falling was regular exercise (O.R. = 1.64, 95% C.I. 0.93-2.93).

CONCLUSION

In our study, we found differences between the group with single and recurrent falls. In the group with single falls, the fall tend to occur outdoors (O.R. = 2.97, 95% C.I. 1.03-8.60) and during the day (O.R. = 3.47, 95% C.I. 1.20-10.0), tend to be accidental (O.R. = 3.16, 95% C.I. 1.05-9.50) and tend to seek medical attention (O.R. = 3.68, 95% C.I. 1.23-11.0). Overall, 32 persons (46.4%) seek medical treatment after their falls, and of these, 65.6% were women. Risk factors for falls should be screened for all elderly.

摘要

目的

跌倒对于老年人来说是一个严重的医学问题。本研究旨在调查新加坡社区居住老年人跌倒的患病率及危险因素。

方法

从基于1990年人口普查的数据库中随机抽取3000名60岁及以上的人群。向2582名有本地完整地址的受试者发送信件。在信中，告知他们调查的目的，并邀请他们在指定日期到综合诊疗所参加问卷调查和临床健康筛查。在预约前一天通过电话提醒参与者，也可根据受试者的方便安排新的预约时间。

结果

我们发现跌倒的患病率为17.2%。其中三分之二的人有单次跌倒，三分之一的人有反复跌倒，反复跌倒定义为在过去一年内跌倒不止一次。以下因素被发现与老年人跌倒增加显著相关：年龄≥75岁（比值比=1.82，95%可信区间0.95 - 3.50）、女性（比值比=2.5，95%可信区间1.40 - 4.48）、马来族（比值比=2.66，95%可信区间1.21 - 5.86）、视力差（比值比=1.7，95%可信区间0.99 - 2.90）、巴氏指数低于20（比值比=1.76，95%可信区间0.94 - 3.28）、每天服用2种或更多药物（比值比=2.1，95%可信区间1.22 - 3.72）以及患有高血压（比值比=1.78，95%可信区间1.06 - 3.01）。女性的跌倒发生率也是男性的两倍。同时，我们发现我们研究组中的女性比男性锻炼更少。跌倒者在活动能力和日常生活活动（ADL）方面也有明显更多的残疾（以较低的巴氏指数反映），这与其他结果一致。唯一能降低跌倒风险的因素是经常锻炼（比值比=1.64，95%可信区间0.93 - 2.93）。

结论

在我们的研究中，我们发现单次跌倒组和反复跌倒组之间存在差异。在单次跌倒组中，跌倒往往发生在户外（比值比=2.97，95%可信区间1.03 - 8.60）和白天（比值比=3.47，95%可信区间1.20 - 10.0），往往是意外跌倒（比值比=3.16，95%可信区间1.05 - 9.50），并且往往会寻求医疗救治（比值比=3.68，95%可信区间1.23 - 11.0）。总体而言，32人（46.4%）跌倒后寻求医疗治疗。其中，65.6%为女性。应对所有老年人筛查跌倒的危险因素。