综合护理干预预防社区老年高血压或糖尿病患者跌倒的效果评价

Comprehensive Nursing Intervention for Prevention of Accidental Falls of Community Elderly Patients with Hypertension or Diabetes

目的评价综合护理干预预防社区老年高血压或糖尿病患者跌倒的效果。方法 2012年3—9月,采用典型抽样法抽取石河子市3个样本社区老年高血压或糖尿病患者共100例为研究对象,采用随机数字表法将患者分为对照组和干预组,每组50例。对照组不给予任何护理干预措施,本课题研究结束后发放跌倒相关健康宣传资料;干预组实施综合护理干预措施,主要包括健康教育、用药干预、运动干预、饮食干预、环境干预及日常生活干预,每月家访1次,6个月后对两组患者干预前后的跌倒发生率、跌倒危险因素认知率、预防跌倒行为进行评价。结果 (1)干预前对照组跌倒发生率为18.0%(9/50),干预组为24.0%(12/50),差异无统计学意义(χ2=0.542,P>0.05);干预后对照组跌倒发生率为26.0%(13/50),干预组为8.0%(4/50),差异有统计学意义(χ2=5.741,P<0.05)。对照组干预前后跌倒发生率比较,差异无统计学意义(χ2=0.932,P>0.05);干预组干预前后比较,差异有统计学意义(χ2=4.762,P<0.05)。(2)干预前两组跌倒危险因素认知率比较,差异均无统计学意义(P>0.05);干预后比较,差异均有统计学意义(P<0.05)。对照组干预前后跌倒危险因素认知率比较,差异均无统计学意义(P>0.05);干预组干预前后比较,差异均有统计学意义(P<0.05)。(3)干预前两组预防跌倒行为比较,差异均无统计学意义(P>0.05);干预后比较,除定期健康体检,浴室、厕所安装扶手2项差异无统计学意义外,其他项目间差异均有统计学意义(P<0.05)。对照组干预前后预防跌倒行为比较,差异均无统计学意义(P>0.05);干预组干预前后预防跌倒行为比较,除定期健康体检,浴室、厕所安装扶手,上下楼梯扶安全扶手3项差异无统计学意义外,其他项目间差异均有统计学意义(P<0.05)。结论综合护理干预能有效提高老年高血压或糖尿病患者跌倒认知水平,促使其采取措施以预防跌倒的发生,社区医务人员应积极开展综合护理干预以提高社区老年患者生存质量。

Objective To study the effectiveness of comprehensive nursing intervention in prevention of accidental falls of community elderly patients with hypertension or diabetes. Methods One hundred elderly patients with hypertension or diabe- tes collected from March to September in 2012, were divided randomly into control and intervention groups, 50 in each. Inter- vention group were given comprehensive nursing intervention such as interventions of drug, exercise, diet, environment and dai- ly life, health education, monthly home visit. The fall incidence, cognitive rate of fall risk factors, fall preventing behaviors were evaluated after 6 months. Results （ 1 ） Before intervention, the fall incidence was 18.0% （9/50） in control group, 24. 0% （12/50） in intervention group, the difference was not significant （χ2 = 0. 542, P 〉 0.05）, but after intervention, 26. 0% （13/50）, 8.0% （4/50）, respectively, the difference was significant （χ2 = 5. 741, P 〈 0. 05 ）. There was no sig- nificant difference between pre - and post - intervention in control group （ χ2 = 0. 932, P 〉 0.05 ）, but was in intervention group （ χ2 = 4. 762, P 〈 0. 05）. （2） Before intervention, there ware no significant differences in cognitive rate of fall risk fac- tors between 2 groups （ P 〉 0. 05 ）, but there were after intervention （ P 〈 0.05 ）. There was no significant difference in cogni- tive rate of fall risk factors between pre - and post - intervention in control group （ P 〉 0. 05 ）, but there was in interventiongroup （ P 〈 0. 05）. （3） There was no significant difference in fall preventing behaviors between 2 groups before intervention （P 〉 0. 05）, but after intervention there was except in regular physical examination and installing handrails in bathrooms and toilets （P 〈 0. 05） ; In control group, there was no significant difference between pre - and post - intervention （P 〉 0. 05）, but there was in intervention group except in regular physical examination, installing handrails in bathrooms and toilets, and holding hand- rails when going up - or down - stairs （P 〈 0. 05 ）. Conclusion Comprehensive nursing intervention can improve effectively the fall cognitive levels of community elderly patients with hypertension or diabetes, to impel them to take measures to prevent oc- currence of accidental falls. Community medical staff should carry out actively comprehensive nursing intervention to improve the survival quality of elderly patients.