武汉市青山区社区老年慢性病患者药物因素对跌倒的影响及预测模型研究

Influence of drug factors on falls in elderly patients with chronic diseases in the communities of Wuhan Qingshan district and research on prediction model

目的分析武汉市青山区社区老年慢性非传染性疾病(以下简称“慢性病”)患者药物因素对跌倒的影响,构建风险预测模型。方法采用整群随机抽样方法,选取武汉市青山区4个社区608例老年慢性病患者为调查对象,收集患者年龄、性别、用药情况、跌倒发生情况等信息,通过多因素Logistic回归模型分析影响用药后跌倒发生的因素,建立跌倒风险列线图预测模型,并应用Bootstrap法验证模型效能。结果608例老年慢性病患者中,152例(25%)发生用药后跌倒,多因素Logistic回归分析显示,女性[OR=1.835,95%CI(1.228,2.742),P=0.003]、使用降糖药[OR=2.721,95%CI(1.727,4.286),P<0.001]、使用镇静催眠药[OR=1.948,95%CI(1.220,3.111),P=0.005]、使用降压药[OR=1.779,95%CI(1.119,2.829),P=0.015]、服用≥2种药物[OR=2.251,95%CI(1.309,3.869),P=0.003]、服药依从性差[OR=3.048,95%CI(1.926,4.824),P<0.001]等6个因素是用药后跌倒的危险因素。根据上述因素构建跌倒风险列线图预测模型,模型验证结果显示,分类校正曲线贴合较为紧密,受试者工作特征曲线下面积为0.7200[95%CI(0.6695,0.7706),P<0.05]。结论武汉市青山区社区老年慢性病患者跌倒发生率较高,社区医务人员及家属应给予重视,建立的预测模型有较好的预测价值,有助于采取针对性的干预措施,预防和降低社区老年慢性病患者跌倒的发生。

Objective To analyze the influence of drug factors on falls in the elderly patients with chronic diseases in the communities of Wuhan Qingshan district,and to construct a prediction model.Methods The elderly with chronic diseases in four communities of Wuhan Qingshan district were selected as the subjects by cluster random sampling method,the information on patients'age,gender,medication,and occurrence of falls of the patients were collected,and the fall-related drug risk factors were analyzed by multivariate Logistic regression model,the fall risk line chart prediction model was established,and the effectiveness of the model was verified by Bootstrap method.Results Among the 608 elderly patients with chronic diseases,152(25%)experienced falls after administration.The results of multivariate Logistic regression analysis showed that females(OR=1.835,95%CI 1.228 to 2.742,P=0.003),using hypoglycemic drugs(OR=2.721,95%CI 1.727 to 4.286,P<0.001),using sedative-hypnotic drugs(OR=1.948,95%CI 1.220 to 3.111,P=0.005),using antihypertensive drugs(OR=1.779,95%CI 1.119 to 2.829,P=0.015),taking two or more drugs(OR=2.251,95%CI 1.309 to 3.869,P=0.003),and poor medication compliance(OR=3.048,95%CI 1.926 to 4.824,P<0.001)were risk factors for falls after medication.Based on the above influencing factors,a nomogram model was established to predict falls in elderly patients;the verification results showed that the classification calibration curves fit closely,and the area under the ROC curve was 0.7200(95%CI 0.6695 to 0.7706,P<0.05).Conclusion The incidence of falls among the elderly with chronic diseases in the community is high in Qingshan district of Wuhan,and community medical staff and their families should pay attention to them.The prediction model has good predictive value,which is benefit to adopt targeted intervention measures to prevent and reduce the occurrence of falls in elderly patients with chronic diseases in the community.