北京市社区老年人跌倒原因的多水平模型分析

Multilevel model analysis of causes of falls in the community-dwelling older population in Beijing

目的了解老年人跌倒的发生情况，并分析老年人跌倒的原因，为其预防提供科学依据。方法采用分层整群抽样的方法抽取北京市某社区60岁及以上老年人，按照统一设计的调查问卷，以面对面询问的方式进行人户调查，对跌倒的原因进行多水平模型分析。结果共调查1512例老年人，272例在过去1年中跌倒，发生率为18．0％，其中女性180例，跌倒发生率20．1％（180／893）；男性92例，跌倒发生率14．9％（92／619），女性跌倒发生率高于男性（x2=7．45，P=0．006）。272例跌倒者共发生379次跌倒，其中与健康问题相关的跌倒次数300次（79．2％），与行为及心理因素相关的跌倒次数291次（76．8％），与环境因素相关的跌倒次数284次（74．9％）；健康问题中平衡能力差是老年人跌倒最主要的原因、其次是下肢无力，行为及心理因素中注意力不集中是跌倒最主要的原因，环境因素中地面不平是跌倒最主要的原因。多水平模型分析结果显示，个体间差异对跌倒为自身健康原因、除自身健康外的其他个人原因及为外部原因均有影响；个体间差异对跌倒为自身健康原因的主要影响因素为地点（住所内跌倒），对跌倒为其他个人原因的主要影响因素为地点（住所外跌倒），对跌倒为外部原因的主要影响因素为跌倒季节的夏季和跌倒时点的深夜。结论北京市社区老年人跌倒的发生率较高，老年人跌倒是多因素交互作用的结果，应提高对导致跌倒因素的识别，有针对性地采取措施，才能有效防范老年人跌倒。

Objective To investigate the incidence and of falls in the communitydwelling elderly people in Beijing in order to provide the scientific evidence on prevention. Methods A cross sectional study was conducted in a community in Beijing. Totally 1512 people aged 60 years and over were recruited by using the stratified cluster sampling method. Information about causes of falls was collected with a standardized structured questionnaire by facetoface interview. Causes of falls in the elderly were analyzed by multilevel model analysis. Results The fall incidence rate was 18.0% （272/1512） during the past year, and the total frequency of falls was 379 times. There was a significant difference in fall incidence rate between females and males [20.1 % （180/893） vs. 14.90% （92/619）, Z2=7.45, P〈0.01]. Among the 379 times of falls, 300 times（79.2%）were related to health problems, 291 times （76.80/00）were related to behavioral and psychological factors, and 284 times （74.9%） were related to environmental factors. Poor balance was the most common cause of falls as to health problems, followed by leg weakness. Attention problems and uneven ground were the most common cause of falls as to behavioral and psychological factors and environmental factors respectively. Multilevel model analysis showed that individual variability had influences on the self reasons and the external reasons for falls. For selfhealth reason, the main influence factor for falls was location （falls at home）, and for the other selfreasons, the main influence factor for falls waslocation （falls outside home） ; but for external reasons, the main influence factors for falls were season （summer） and fall time （late night）. Conclusions The fall incidence rate is high in the community dwellers in Beijing. There are multipleinteraction factors for falls in the elderly. Recognition of risk factors for falls and intervention strategies targeting the falls should be strengthened to prevent the occurrence of falls in elderly people.