老年综合评估及干预在跌倒风险患者中的临床应用

发布时间：2018-08-24 08:01

【摘要】：目的本研究通过在住院跌倒高风险老年患者的临床治疗中引入老年综合评估(Comprehensive Geriatric Assessment,CGA)及干预,观察CGA及干预在降低老年患者的跌倒风险、降低跌倒发生率、缓解老年患者的跌倒恐惧心理、改善平衡能力、提高患者生存质量等方面的作用,为推进CGA及干预在老年患者中的临床应用提供依据。方法选取2015年10月至2016年9月就住于华北理工大学附属医院老年病科的年龄≥60岁的老年患者进行跌倒风险量表评估,将最终筛查出的224例跌倒评分等级为高风险的患者作为研究对象,采用随机分组的方法分成干预组和对照组,每组患者112例,其中对照组男性48例,女性64例,平均年龄77.18±7.76岁;干预组男性51例,女性61例,平均年龄76.46±7.37岁。对入选患者进行两次跌倒风险评估、平衡能力的评估、跌倒效能量表评估及生存质量评估,分别于入院2日内及干预3个月时完成,记录各项评分结果。评估时同时采集患者的姓名、性别、年龄、婚姻状况、职业、吸烟饮酒情况等一般个人资料,收集血糖、血脂、血压、电解质、患病情况等医学资料。对照组患者给予常规的住院诊疗、健康知识教育及常规的医学护理,干预组在上述诊疗及护理措施的基础上,实施老年综合评估及干预的内容,患者出院后每2周进行电话随访1次,随访的内容主要为对干预措施的执行情况、是否有新的需要干预的问题,干预执行3个月后对干预组患者进行第二次CGA评估,详细记录两次评估的结果。使用Excel 2013软件建立数据库,应用SPSS21.0统计学软件进行统计数据分析,计数资料采用例数和百分比进行表示,两组之间的比较采用X2检验;计量资料采用均数±标准差((?)±s)来表示,两组间及组内比较采用t检验,认为P0.05为差异具有统计学意义。结果1两组患者在性别、年龄、婚姻状况、文化水平、吸烟、饮酒等基础资料方面进行比较,差异无统计学意义(P0.05)。两组的空腹血糖、血压、总胆固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、尿酸、体重指数比较,差异无统计学意义(P0.05)。2两组患者入院时的跌倒风险评分进行比较,差异无统计学意义(P0.05),提示两组间具有可比性。研究结束后两组患者跌倒风险评分与入院时比较均有所降低,干预组与对照组相比下降更明显(P0.01)。3干预结束后两组患者跌倒发生率比较,干预组跌倒的发生率明显低于对照组,两组差异具有统计学意义(P0.05)。4两组患者平均住院日比较,干预组明显低于对照组,差异具有统计学意义(P0.01)。5两组患者入院时的BBS评分相比,差异无统计学意义(P0.05)。研究后两组患者的评分与研究之前比较,均有所改善(P0.05),干预组较对照组明显升高,差异具有统计学意义(P0.01)。6两组患者入院时的MFES评分相比,差异无统计学意义(P0.05)。研究后两组患者的评分较研究前均有所改善(P0.05),干预组与对照组相比升高更明显,差异具有统计学意义(P0.01)。7两组患者研究前生存质量各个方面的评分相比,差异无统计学意义(P0.05)。研究结束后,对照组仅在躯体疼痛、情感职能、社会功能及总分方面与研究前比较差异有统计学意义(P0.05),干预组生存质量各项评分较研究前均有所增加(P0.05),且与对照组相比增加更明显,差异具有统计学意义(P0.05)。结论1老年综合评估及干预应用于住院跌倒高风险的老年患者,可以有以下效果:1)降低患者的跌倒风险评分及跌倒发生率。2)改善患者的平衡能力、缓解患者的恐惧跌倒心理。3)降低患者的平均住院日。4)提高老年患者的生存质量。
[Abstract]:Objective To observe the effects of CGA and intervention on reducing the risk of falls, reducing the incidence of falls, alleviating the fear of falls, improving the balance ability and improving the balance ability of elderly patients. Methods From Oct. 2015 to Sept. 2016, 224 elderly patients aged 60 or older in the geriatric department of the Affiliated Hospital of North China University of Technology were selected and evaluated by the Fall Risk Scale. High-risk patients were randomly divided into intervention group and control group, with 112 patients in each group, including 48 males and 64 females, with an average age of 77.18 [7.76]; 51 males and 61 females, with an average age of 76.46 [7.37], in the intervention group. Assessment, Fall Effectiveness Scale Assessment and Quality of Life Assessment were completed within 2 days after admission and 3 months after intervention, and the results were recorded. Material: Patients in the control group were given routine hospitalization, health education and routine medical care. On the basis of the above-mentioned diagnosis, treatment and nursing measures, the intervention group was given the contents of comprehensive evaluation and intervention for the elderly. The patients were followed up by telephone every two weeks after discharge. The main contents of the follow-up were the implementation of the intervention measures and whether there were any new ones. The second CGA evaluation was conducted three months after the intervention, and the results of the two evaluations were recorded in detail. Excel 2013 software was used to establish a database and SPSS21.0 statistical software was used to analyze the statistical data. The counting data were expressed by the number and percentage of cases. The comparison between the two groups was performed by X2 test. Results 1 There was no significant difference in sex, age, marital status, educational level, smoking and drinking between the two groups (P 0.05). There was no significant difference in blood pressure, total cholesterol, triglyceride, low density lipoprotein, high density lipoprotein, uric acid, and body mass index between the two groups (P 0.05). There was no significant difference in the fall risk score between the two groups at admission (P 0.05), suggesting that there was comparability between the two groups. Compared with the control group, the incidence of falls in the intervention group was significantly lower than that in the control group (P 0.01). 3 Compared with the control group, the incidence of falls in the intervention group was significantly lower than that in the control group. Statistical significance (P 0.01). 5 There was no significant difference in BBS scores between the two groups at admission (P 0.05). After the study, the scores of the two groups were improved compared with those before the study (P 0.05). The intervention group was significantly higher than the control group, the difference was statistically significant (P 0.01). 6 There was no statistical difference in MFES scores between the two groups at admission. Significance of learning (P 0.05). After the study, the scores of the two groups were improved (P 0.05). Compared with the control group, the scores of the intervention group increased more significantly, the difference was statistically significant (P 0.01). 7 There was no significant difference between the two groups in all aspects of quality of life before the study (P 0.05). After the study, the control group only had somatic pain. There were significant differences in emotional function, social function and total score between the intervention group and the pre-study group (P 0.05). The scores of quality of life in the intervention group increased (P 0.05), and increased more significantly than the control group, the difference was statistically significant (P 0.05). Conclusion 1 The comprehensive evaluation and intervention of the elderly for the high risk of fall in hospitalization. Elderly patients, can have the following effects: 1) reduce the risk score of falls and the incidence of falls. 2) improve the balance of patients, ease the fear of falls. 3) reduce the average hospitalization days of patients. 4) improve the quality of life of elderly patients.
【学位授予单位】：华北理工大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R473

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