社区老年人不同跌倒恐惧水平的影响因素

Influencing factors of different levels of fear for falling among community-dwelling older people

【摘要】目的 探讨老年人跌倒恐惧的影响因素,为降低老年人的跌倒恐惧制定精准的干预方案提供参考。方法 采用连续性抽样的方法,选取2023年7月至2024年2月中国人民解放军总医院第一医学中心跌倒门诊收治的207例老年人为研究对象,采用一般资料调查表、国际跌倒效能感量表、心理韧性量表、社会支持评定量表、简易应对方式量表及匹兹堡睡眠质量指数对患者进行调查。根据跌倒恐惧得分将患者分为低、中、高水平跌倒恐惧组,3组分别有113例、48例、46例老年患者。采用SPSS 29.0统计软件进行数据分析。根据数据类型,分别采用方差分析、Kruskal Wallis H检验、χ²检验或Fisher精确检验进行组间比较。采用多分类logistic回归模型分析不同跌倒恐惧水平的影响因素。结果 207例患者跌倒恐惧得分为21.0(17.0,32.0)分。低、中、高水平跌倒恐惧组的老年人分别占54.59%(113/207)、23.19%(48/207)、22.22%(46/207)。3组患者近一年跌倒史、跌倒骨折史、患有神经系统疾病、使用助行器、听力异常、躯体感觉异常、心理韧性和睡眠等方面比较,差异有统计学意义(P＜0.05)。多分类logistic回归分析显示,跌倒骨折史、神经系统疾病、躯体感觉异常及心理韧性水平低是中等水平跌倒恐惧的危险因素(P＜0.05)；近一年发生过跌倒、跌倒骨折史、听力异常、躯体感觉异常、使用助行器、心理韧性水平低及睡眠质量差是老年人高水平跌倒恐惧的危险因素(P＜0.001)。结论 老年人的跌倒恐惧水平存在异质性,医护人员应重点关注心理韧性水平较低及具有较高跌倒风险的老年人,将心理韧性评估纳入跌倒恐惧的管理中来,制定个性化的干预策略,从而减轻跌倒恐惧。

基金项目:国家重点研发计划(2023YFC3603905)；解放军总医院青年自主创新科学基金(22QNFC033)

【Abstract】Objective To explore the influencing factors for fear of falling in the elderly in order to provide a reference for develop-ing precise intervention programs to reduce the fear of falling in them. Methods With continuous sampling, 207 elderly patients who attended the Outpatient Clinic of Falling of First Medical Center of Chinese PLA General Hospital were subjected from July 2023 to February 2024. They were investigated by using a general information questionnaire, falls efficacy scale international, Connor-Davidson resilience scale, social support rating scale, simplified coping style questionnaire, and Pittsburgh sleep quality index. Based on their score for fear of falling, the participants were stratified into low-, moderate-, and high-level fear of falling groups (113,48 and 46 cases, respectively). Statistical analyses were conducted using SPSS 29.0. Intergroup differences were compared via AVOVA, Kruskal-Wallis H test, Chi-square test or Fisher′s exact probability test depending on data type. Multinomial logistic regression analysis was employed to identify the influencing factors for fear of falling at different levels. Results The 207 patients had a median score of 21.0 (17.0,32.0) for fear of falling. The participants of low-, moderate-, and high-level fear of falling accounted for 54.59% (113/207), 23.19% (48/207), and 22.22% (46/207), respectively. Significant differences were observed among the three groups in terms of falling history within one year, fracture due to falls, neurological disorders, using walking aids, hearing impairment, somatosensory impairment, psychological resilience, and sleep quality (P<0.05). Multinomial logistic regression analysis indicated that fracture due to falls, neurological disorders, somatosensory impairment, and low psychological resilience were risk factors for moderate-level fear of falling (P<0.05); falling history within one year, fracture due to falls, hearing impairment, somatosensory impairment, using walking aids, low psychological resilience and poorer sleep quality were risk factors for high-level fear of falling (P<0.001). Conclusion Heterogeneity exists in fear of falling among older adults. Healthcare professionals should focus on those with lower psychological resilience and higher risk for falls, incorporate resilience assessment into fear management, and develop individualized interventions to reduce the fear of falling.

This work was supported by the National Key Research and Development Program of China (2023YFC3603905) and the Young IndependentInnovative Science Foundation of Chinese PLA General Hospital (22QNFC033).