老年人跌倒后心理障碍及其影响因素分析

Analysis on the mental disorders in the elderly after falling and its influencing factors CHEN

目的 了解社区老年人跌倒后心理障碍的发生情况及其影响因素.方法 应用＂事件影响量表＂（IES）和＂害怕跌倒评定量表＂（FFS）,对广州市某社区近1年内曾有跌倒史的184名60岁以上的老年人进行心理障碍状况的结构式访谈调查,同时以56名同期无跌倒史的老年人作为对照,利用分类树模型进行分析,并与logistic回门分析结果进行比较.结果 IES评分显示跌倒造成创伤后应激障碍（PTSD）发生率为8.2%（平均分为16.07±9.52）,高龄、视力不好、听力不好、受伤及活动减少者评分较高;分类树分析结果显示跌倒后活动减少和需有人扶起是危险因素,活动没有减少是保护因素.FFS评分显示害怕跌倒的心理障碍发生率为58.2%（平均分为22.29±10.25）,高龄、视力不好、听力不好、独居者评分较高;分类树分析结果提示活动减少、年龄80岁以上是害怕跌倒心理的危险因素,活动没有减少及IES总分≤9分是保护因素.logistic回归分析的结果显示需有人扶起（OR=6.20,95%CI：1.32～29.12）是PTSD的危险因素;而年龄（OR=4.62,95%CI：1.80～11.83;OR=4.06,95%CI：1.39～11.87）、受伤（OR=6.26,95%CI：2.60～15.09）、IES总分高（OR=8.75,95%CI：3.53～21.70;OR=11.98,95%CI：3.88～37.02）和活动减少（OR=5.26,95%CI：2.29～12.06）是害怕跌倒的危险因素.结论 老年人跌倒后心理障碍的发生率较高,IES及FFS评分高、高龄及跌倒后活动减少、需要有人扶起是其危险因素.

Objective To explore the prevalence and its influencing factors on mental disorders in older people after falling in a community from Guangzhou city. Methods 184 people over 60years of age had ever fallen within the past year in a community, were investigated by structured interview survey on their mental disorders in Guangzhou, with the impact of event scale（IES）and fear fall scale（FFS）. Another 56 people over the age of 60 had never fallen at the same time were selected as controls. Data was analyzed by classification tree and logistic regression analysis.Results IES score showed that there were 8.2% older people suffering from PTSD after falling （average score 16.07 ± 9.52）. People who were at older age, with either bad eyesight or hearing,having had injury or decreased activity had higher scores. Results from classification tree analysis showed that decreased activity and helped by others after falling were risk factors of PTSD while not having decreased activity was protective factor. FFS score showed that 58.2% of the older people suffering from FFS after falling（average score 22.29± 10.25）, people who were at older age, having had bad eyesight or hearing, not living with spouse or children etc. had higher scores while Classification Tree Analysis showed that factors as decreased activity or older than 80 years of age were at risk of FFS. People who did not have decreased activity or their IES score was nine or lower were protective factors. Data from thc logistic regression analysis showed that raised by others after falling（OR=6.20,95%CI： 1.32-29.12）were risk factors of PTSD while older age（OR=4.62,95%CI：1.80-11.83; OR = 4.06,95%CI： 1.39-11.87）, injury（OR= 6.26,95%CI： 2.60-15.09）, higher IES score （OR=8.75,95%CI： 3.53-21.70; OR= 11.98,95%CI： 3.88-37.02）and decreased activity（OR=5.26,95%CI： 2.29-12.06）were risk factors of FFS. Conclusion There had been a high incidence of mental disorders after falling among the elderly. Older age and decreased activity were the risk factors in this study.