社区跌倒高风险老年人防跌倒项目参与意愿及其影响因素研究

Participation Intention in Fall-prevention Project and Related Influencing Factors in Community-living Elderly Residents at High Risk of Falls

背景随着人口老龄化进程加快,老年人防跌倒项目的开展刻不容缓。我国防跌倒项目虽有零星开展,但以运动干预为主要内容的综合性防跌倒项目较少见,而针对社区跌倒高风险老年人综合性防跌倒项目参与意愿的调查尚未见报道。目的了解跌倒高风险老年人参与综合性防跌倒项目的意愿,分析其影响因素,为综合性防跌倒项目的实施提供理论依据。方法根据经济和地理位置分别抽取上海市浦东新区塘桥社区(中心城区)、青浦区赵巷社区(远郊)、崇明区港沿社区(远郊)为研究现场,使用跌倒风险初筛量表(FROP-Com Screen)对2018—2019年在3个社区参加体检的5426例≥65岁老年人进行初筛,纳入FROP-Com Screen评分>3分,即有跌倒风险的老年人;进一步使用修订版社区老年人跌倒风险评估工具(MFROP-Com Tool)评估有跌倒风险老年人,纳入MFROP-Com Tool总分≥11.5分,即跌倒高风险老年人。本研究所用调查问卷由6部分构成:基本情况调查表、FROP-Com Screen、MFROP-Com Tool、自行设计的跌倒情况调查表、患者健康问卷(PHQ-9)、广泛性焦虑量表(GAD-7)。结果本研究共纳入318例跌倒高风险老年人,其中62例(19.5%)认为跌倒不可预防。地面光滑〔73例(23.0%)〕、注意力不集中〔64例(20.1%)〕和身体不适〔59例(18.6%)〕是调查对象认为导致跌倒的前3位原因。318例跌倒高风险老年人中,214例(67.3%)表示愿意参加防跌倒项目。不同居住地区、文化程度、助行器使用情况、睡眠质量自评情况、慢性病种数、足部疾病情况、运动爱好、近1年跌倒情况、对跌倒是否可预防认知情况的老年人参加防跌倒项目的意愿比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,市区老年人〔OR(95%CI)=7.828(2.898,21.149)〕、喜欢运动的老年人〔OR(95%CI)=3.474(1.703,7.087)〕、近1年发生过跌倒的老年人〔OR(95%CI)=2.806(1.364,5.773)〕和认为跌倒可预防的老年人〔OR(95%CI)=4.124(1.749,9.726)〕更倾向参加防跌倒项目(P<0.05)。结论跌倒高风险老年人对于防跌倒的认识有一定局限性,大部分跌倒高风险老人愿意参加综合性防跌倒项目。为了更好地实施综合性防跌倒项目,需进一步改善跌倒高风险老年人对防跌倒的认知,提升其防跌倒项目参与意愿。

Background With the aging of the population,it is essential to implement fall prevention programs for the elderly.Although China has carried out fall prevention programs sporadically,among which comprehensive fall prevention programs centered on exercise intervention are rare,and there have been no investigations about the willingness of elderly people at high risk of falls in the community to participate in comprehensive fall prevention programs.Objective To examine the intention of community-living elderly residents at high risk of falls to participate in comprehensive fall-prevention programs,and associated factors,providing a theoretical basis for the implementation of such programs.Methods By economic level and geographical location,we selected three communities from Shanghai as research settings,namely,Tangqiao Community in Pudong New Area(central urban area),Zhaoxiang Community in Qingpu District(outer suburb)and Gangyan Community in Chongming County(outer suburb).Elderly people aged 65 and above who participated in physical examinations in the three communities from 2018 to 2019 were invited to attend a survey using a questionnaire consisting of demographics,FROPCom Screen,MFROP-Com Tool,self-designed fall risk questionnaire,Patient Health Questionnaire-9(PHQ-9),and Generalized Anxiety Disorder scale(GAD-7).Individuals with the FROP-Com Screen scale score>3 points were identified with risk of falls,among whom those with total score of MFROP-Com Tool≥11.5 points(high risk of falls)were included finally.Results In total,318 cases were detected with high risk of falls,among whom 62(19.5%)thought falls were unpreventable.Slippery floo〔r 73 respondent(s 23.0%)〕,inattention〔64 respondent(s 20.1%)〕and physical discomfor〔t 64 respondent(s 20.1%)〕were reported to be the three leading causes of falls.Two hundred and fourteen(67.3%)were willing to participate in fall prevention programs.The level of intention to participate in fall prevention programs differed significantly in the participants according to living setting,educational level,use of a walker,self-assessed sleep quality,number of chronic diseases,foot disease prevalence,exercise habits,history of falls in the past year,and cognition of whether falls can be prevented(P<0.05).Binary Logistic regression analysis showed that living in urban area〔OR(95%CI)=7.828(2.898,21.149)〕,having an exercise habit〔OR(95%CI)=3.474(1.703,7.087)〕,previous history of falls〔OR(95%CI)=2.806(1.364,5.773)〕,and having an idea of falls are preventable〔OR(95%CI)=4.124(1.749,9.726)〕were associated with higher level of intention to participate in an fall prevention program(P<0.05).Conclusion In general,the community-living elderly residents with high risk of falls had limited understanding of fall prevention,but most of them were willing to participate in fall prevention programs.To promote the implementation of comprehensive fall prevention programs,it is necessary to improve their awareness of fall prevention and enhance their willingness to participate.