住院成年人和老年人跌倒的预后因素：流行病学和临床分析

IF 2.2 3区医学 Q3 CRITICAL CARE MEDICINE

Injury-International Journal of the Care of the Injured Pub Date : 2024-10-18 DOI:10.1016/j.injury.2024.111966

Maria Nathalia Silva , Yanne da Silva Camargo , Tathiane Ribeiro da Silva , Andrea M. Bernardes da Silva , Diogo Fernandes dos Santos , Douglas Eulálio Antunes

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引用次数: 0

摘要

背景：众所周知，跌倒会造成轻微至严重的伤害，导致局部或全身性病变。解决与跌倒相关的预后因素对于通过实施患者护理方案预防这种不良事件至关重要。本研究旨在探讨影响成人和老年患者跌倒的流行病学、临床和药物预后因素，并利用生存曲线分析评估这些因素的发生时间和影响：一项回顾性观察队列研究纳入了 176 名发生过跌倒的住院患者，分为成人（结果：176 名患者中有 25.9% 的人发生过跌倒）和老年人（结果：176 名患者中有 25.9% 的人发生过跌倒）：总体而言，25.9%的成人和 33.3%的老年人受到了某种形式的伤害（轻度或中度）。在 60 岁以下的患者中，77.6% 的患者在跌倒时是独自一人，而在 60 岁及以上的患者中，这一比例为 50%（P < 0.001）。从自身高度跌落是最常见的情况，在 60 岁以下的患者中占 46.6%，在老年患者中占 66.7%（p = 0.011）。在 60 岁以下的成年人中，既往酗酒史（p = 0.0276）、独自跌倒（p = 0.0002）、使用苯二氮卓类药物（p = 0.0001）、抗心律失常/抗高血压药物（p = 0.0005）和抗精神病药物（p = 0.0001）等因素与跌倒有显著相关性。老年人跌倒的重要因素包括：从自身高度跌倒（p = 0.0112）、肌肉无力（p = 0.0183）、步态障碍（p = 0.0443）、血管扩张剂（p = 0.0107）、抗组胺药（p = 0.0003）和降糖药（p = 0.0041）。生存曲线分析表明，与老年妇女相比，60 岁以下妇女跌倒的预后较差（p = 0.038）。与 60 岁以下的成年人相比，老年人使用阿片类药物（p = 0.045）和肌肉无力（p = 0.037）是不良预后因素。在 Cox 回归中，与 60 岁以上女性相比，60 岁以下患者中只有女性的风险较高（HR=1.47）（p = 0.0014）。虽然在多变量分析中并不显著，但肌无力（p = 0.066）和使用阿片类药物（p = 0.0545）的比例危险度分别为 1.37 和 1.12：结论

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Prognostic factors of falls in hospitalized adults and elderly: An epidemiological and clinical analysis

Background

Falls are known to cause injuries ranging from minor to severe, resulting in local or systemic lesions. Addressing prognostic factors associated with falls is crucial for preventing this adverse event through the implementation of patient care protocols. This study aimed to explore the epidemiological, clinical, and pharmacological prognostic factors influencing falls in adult and elderly patients, assessing the timing and impact of these factors using survival curve analysis.

Methods

A retrospective observational cohort study included 176 hospitalized patients experiencing falls, categorized into adults (<60 years) and elderly (≥60 years). Binomial tests and logistic regression assessed variable associations, while Kaplan-Meier curves and Cox proportional hazards models analyzed survival.

Results

Overall, 25.9 % of adults and 33.3 % of the elderly experienced some form of injury (minor or moderate). Patients were alone during the fall in 77.6 % of cases for those under 60, compared to 50 % for those 60 and older (p < 0.001). Falls from own height were the most common, occurring in 46.6 % of patients under 60 years and 66.7 % of elderly patients (p = 0.011). Among adults under 60, factors such as past alcohol history (p = 0.0276), falling alone (p = 0.0002), benzodiazepine use (p = 0.0001), antiarrhythmic/antihypertensive medication (p = 0.0005), and antipsychotics (p = 0.0001) were significantly associated with falls. In the elderly, significant factors included falling from one's own height (p = 0.0112), muscle weakness (p = 0.0183), gait disorders (p = 0.0443), vasodilators (p = 0.0107), antihistamines (p = 0.0003), and hypoglycemic agents (p = 0.0041). Survival curve analysis indicated women under 60 had a worse prognosis for falls compared to elderly women (p = 0.038). For the elderly, opioid use (p = 0.045) and muscle weakness (p = 0.037) represented poor prognostic factors compared to adults under 60. In Cox regression, only female sex in patients under 60 showed a higher risk (HR=1.47) compared to women over 60 (p = 0.0014). Although not significant in multivariate analysis, muscle weakness (p = 0.066) and opioid use (p = 0.0545) had proportional hazards of 1.37 and 1.12, respectively.

Conclusion

Female sex indicated poorer prognosis in <60 s, while opioids and muscle weakness were concerning for the elderly. These findings emphasize the need for tailored care protocols to stratify patient fall risk and prognosis during hospitalization and develop effective preventive strategies in healthcare.

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来源期刊

Injury-International Journal of the Care of the Injured 医学-急救医学

CiteScore

4.00

自引率

8.00%

发文量

699

审稿时长

96 days

期刊介绍： Injury was founded in 1969 and is an international journal dealing with all aspects of trauma care and accident surgery. Our primary aim is to facilitate the exchange of ideas, techniques and information among all members of the trauma team.