用药数量和Barthel指数对住院老年人跌倒的影响

Effects of multiple drugs and Barthel index on falls in hospitalized elderly

目的探讨住院老年人跌倒的发生情况以及影响因素。方法收集2019—2021年于南京市第一医院住院治疗的老年人,根据病例系统跌倒发生情况,共纳入跌倒老年人(≥60岁)183例,收集研究对象的一般资料、合并疾病、用药情况以及实验室检查指标,并收集Barthel评分、跌倒坠床评分,分析跌倒老年人的基本特征。根据性别、年龄匹配,选取同期住院治疗的未发生跌倒的174例老年人作为对照组,比较跌倒组与对照组临床特征的差异,并采用多因素Logistic回归分析影响老年人跌倒的影响因素。结果183例发生跌倒的老年人跌倒发生时间主要集中在6:00~9:00(19.8%)以及17:00~20:00(17.0%);发生地点主要是病房内(68.9%),其次是卫生间(18.0%)。单因素分析显示,跌倒组与对照组BMI、Na、Cl、Ca、Hb、白蛋白、总蛋白、血糖、用药数量、跌倒坠床评分、Barthel评分以及使用胰岛素、利尿剂、退烧药、助眠药、止疼药、喹诺酮类药物的比例差异均有统计学意义;多因素Logistic回归分析显示,BMI、Hb、血糖、Na、用药数量以及Barthel评分41~60分以及41分以下是住院老年人跌倒的独立影响因素,OR(95%CI)分别为0.922(0.857~0.992)、0.980(0.965~0.995)、1.345(1.186~1.527)、0.872(0.804~0.947)、2.957(1.687~5.181)、2.979(1.157~7.672)、4.419(1.480~13.193)。结论老年人用药数量以及生活自理能力下降是跌倒的危险因素,应对此采取措施,积极预防跌倒。

Objective To investigate the status and influencing factors of falls in hospitalized elderly.Methods A total of 183 elderly patients aged≥60 years old who were hospitalized in Nanjing First Hospital and suffered from fall in hospital from 2019 to 2021 were enrolled in this study.The general characteristics,comorbidities,drug use and laboratory examination indicators of the patients were collected,and Barthel index score and fall score were evaluated.The basic characteristics of the elderly who fell were analyzed.At the same time,gender-and age-matched 174 elderly hospitalized patients who did not suffer from falls were selected as control group.The differences in the clinical indicators were compared between the two groups,and the risk factors of falls in the elderly were analyzed by multivariate Logistic regression.Results The fall occurred mainly at 6:00-9:00 in the morning(19.8%)and 17:00-20:00 in the evening(17.0%)in 183 elderly falling patients.The main place of fall was in the ward(68.9%),followed by the bathroom(18.0%).Univariate analysis showed that there were statistically significant differences in body mass index(BMI),Na,Cl,Ca,hemoglobin(Hb),albumin,total protein,blood glucose,number of drugs,fall score,Barthel index score and the proportion of insulin,diuretics,antipyretic drugs,sleep aids,painkillers and quinolones used between the two groups.Multivariate analysis showed that BMI,Hb,blood glucose,Na,number of drugs and Barthel index score(41-60)were the influencing factors of falls in hospitalized elderly patients(OR=0.922,95%CI:0.857-0.992;OR=0.980,95%CI:0.965-0.995;OR=1.345,95%CI:1.186-1.527;OR=0.872,95%CI:0.804-0.947;OR=2.957,95%CI:1.687-5.181;OR=2.979,95%CI:1.157-7.672;OR=4.419,95%CI:1.480-13.193,respectively).Conclusions Multiple drug use and decreased self-care ability in the elderly are risk factors for falls,and it is important to prevent them in hospital.