老年男性人群跌倒发生率及相关危险因素的现况调查

Prevalence survey on incidence of falls and related risk factors in elderly males

目的系统评估老年男性人群跌倒发生情况,调查与跌倒相关的危险因素。方法在60岁以上老年男性群体中开展调查,评价指标包括受试者一般信息、跌倒史、生活习惯、病史、体检信息、运动能力、肌肉力量、步行能力、平衡能力、认知状态等,研究老年人跌倒发生风险因素及相关损伤情况,根据1年内跌倒史分为跌倒组与非跌倒组,比较两组间各项指标差异,通过单因素与多因素二元logistic回归分析,探索其相关因素。结果完成调查520名,平均(77.21±9.70)岁,近1年内跌倒发生率31.35%;既往跌倒损伤率33.6%,既往跌倒失能发生率31.9%。跌倒高危时间为清晨与深夜,地点是卧室、卫生间,跌倒多在行走中发生,跌倒方式主要为滑倒与绊倒。环境原因主要是地面湿滑、障碍物,个人原因复杂。跌倒组(163名)与非跌倒组(357名)在年龄、日常生活活动能力(ADL)、工具性日常生活活动(IADL)量表、简易精神状态检查表、下肢肌力、单腿平衡(SLBT)、计时“起立-行走”试验、5次坐立试验、步速、功能性步行量表、运动史及多病状态上有差异。单因素Logistic回归分析显示,老年男性人群跌倒发生的危险因素有高龄、IADL功能差、多病状态,以及脑卒中、体位性低血压、消化疾病、肌骨疾病、听觉损失等多种疾病,保护因素有运动史、ADL、认知功能、下肢肌力、SLBT、行走能力等。多因素Logistic回归显示,老年男性人群跌倒的危险因素有高龄(OR=1.085,95%CI:1.026~1.147)、脑卒中(OR=2.528,95%CI:1.118~5.717)、体位性低血压(OR=2.845,95%CI:1.249~6.481),保护因素有良好的ADL(OR=0.944,95%CI:0.931~0.959)、下肢力量(OR=0.842,95%CI:0.784~0.905)、SLBT(OR=0.705,95%CI:0.633~0.786)。结论老年男性人群的跌倒发生率较高,跌倒风险随年龄增加而升高,跌倒后易发生损伤、失能。跌倒与自身原因、时间、环境有关,高龄、日常生活能力水平低、下肢力量与平衡能力下降及有脑卒中、体位性低血压病史的老年男性跌倒风险更高。

Objective To systematically evaluate the incidence of falls in elderly male and investigate the risk factors associated with falls.Methods A study was carried out on men over 60 years old.The general information,history of falls,living habits,medical history,physical examination information,exercise ability,muscle strength,walking ability,balance ability,cognitive status,and other indicators were collected to study the risk factors and related injuries of falls in the elderly.According to the history of falls within one year,the subjects were divided into a fall group and a non-fall group.The differences between the two groups were compared,and the relevant factors were explored by univariate and multivariate logistic regression analysis.Results A total of 520 older subjects were surveyed,with an average age of(77.21±9.70)years.The incidence of falls in the past year was 31.35%.The injury rate of previous falls was 33.6%and the incidence of disability was 31.9%.The highest risk time of falls was early in the morning and late night,and the highest risk places were bedrooms and bathrooms.Most falls occurred during walking,and the main ways of falling were slipping and tripping.The main reasons were slippery ground,obstacles,and complex personal causes.There were significant differences between fall group(n=163)and non-fall group(n=357)in age,activity of daily living(ADL),instrumental activity of daily living(IADL),minimum mental state examination,muscle strength of lower limbs,single leg balance test(SLBT),timed“up and go”test,five-time sit-stand test,gait speed,functional ambulation category scale,exercise history and multimorbidity state.Univariate logistic regression analysis showed that the risk factors for falls in elderly men were advanced age,poor function of IADL,stroke,orthostatic hypotension,digestive disorder,musculoskeletal disorder,hearing loss,and other diseases,and the protective factors included exercise history,ADL,cognitive function,muscle strength of the lower limb,SLBT,and walking ability and so on.Multivariate logistic regression showed that advanced age(OR=1.085,95%CI:1.026~1.147),stroke(OR=2.528,95%CI:1.118~5.717),and orthostatic hypotension(OR=2.845,95%CI:1.249~6.481)were the risk factors for falls in the elderly men,and good ability in ADL(OR=0.944,95%CI:0.931~0.959),lower limb strength(OR=0.842,95%CI:0.784~0.905),and SLBT(OR=0.705,95%CI:0.633~0.786)were the protective factors.Conclusions The incidence of falls in senile males is high,and the risk of fall increases with the increase of age.Injury and disability are common after falls.The related factors include self-reasons,time and environment.Elderly men with low level of ADL ability,insufficient strength of lower limb,poor balance ability,a history of stroke and orthostatic hypotension has a higher risk of falls.