预测中老年人跌倒敏感指标和风险评价等级的研究
发布时间：2019-05-24 23:19
【摘要】：目的：本文对与中老年人跌倒相关的危险因素进行研究,探讨各因素与跌倒的相关程度,从中筛选出能够预测跌倒事件发生的敏感指标,并在此基础上进一步建立能够预测中老年人发生跌倒风险的评价等级。方法：将北京市55岁以上中老年人作为研究对象的抽样范围,最终保留361例有效样本(64.86±6.93岁)。通过问卷采集受试者基本信息、生活习惯、现病史、服药史、跌倒史和运动心理状态信息。通过测试法采集感觉神经肌肉功能、姿势稳定控制和反应能力等指标。第一部分以中老年人是否存在跌倒史为因变量,以可能影响其跌倒的各因素为自变量,进行单因素和多因素Logistic回归分析,筛选敏感指标。第二部分以中老年人的跌倒次数为因变量,进行多分类Logistic回归分析和求解ROC曲线的最佳截断点,以建立评价等级。结果：1.本中有33.80%的人在过去一年中发生过跌倒,其中27.87%跌倒过1次,29.51%跌倒过2次,42.62%跌倒过3次或3次以上。2.筛选可以预测中老年人发生跌倒风险的敏感指标,最终有11个变量进入回归方程,其中女性(OR=2.472)、骨质疏松(OR=1.938)、昏厥/晕眩(OR=1.734)、膝关节主动位置觉角度差值大(OR=1.958)、Romberg 30s睁眼C90 Area面积大(OR=1.998)、选择反应时问长(OR=1.398)、步态中离地时刻髋关节角度大(OR=1.050)、躯干活动范围大(OR=1.076)、以及着地时刻骨盆加速度大(OR=1.545)均是中老年人发生跌倒的危险因素；而10%对比度视力(OR=0.791)和Tandem C90 Angle(OR=0.995)是中老年人发生跌倒的保护因素。3.当标准化总概率为51.174时,预测中老年人发生1次跌倒的约登指数最大,其筛检敏感性为85.3%,特异性为31.5%；当标准化总概率为54.437时,预测中老年人发生2次跌倒的约登指数最大,其筛检敏感性为61.5%,特异性为53.1%；当标准化总概率为56.985时,预测中老年人发生3次跌倒的约登指数最大,其筛检敏感性为50.0%,特异性为65.5%。结论：1.本研究筛选出的敏感指标对中老年人发生跌倒风险的预测效果较好,且敏感指标对跌倒的影响程度各有不同,其由大到小为：10%视力对比敏感度差性别骨质疏松昏厥/晕眩骨盆加速不稳选择反应时行走时躯干晃动幅度大行走时伸髋不充分膝关节主动位置觉角度差大站立时身体侧向晃动明显。提示可据此对中老年人开展有针对性的跌倒预防工作。2.中老年人是否患有骨质疏松、是否曾出现昏厥\晕眩症状、10%对比度视力是否敏感、选择反应是否灵敏以及行走时髋关节伸展是否充分对于中老年人跌倒的发生以及跌倒程度的预判至关重要。3.本研究根据中老年人发生跌倒的跌倒风险指数,建立的预测中老年人发生跌倒风险评价等级为：1≤跌倒风险指数3,无跌倒风险；3≤跌倒风险指数6,低度跌倒风险；6≤跌倒风险指数9,中度跌倒风险；9≤跌倒风险指数≤10,高度跌倒风险。
[Abstract]:Objective: to study the risk factors related to falls in the middle-aged and the elderly, to explore the correlation between each factor and the degree of falls, and to screen out the sensitive indexes that can predict the occurrence of falls. On this basis, the evaluation grade which can predict the risk of falls in the middle-aged and the elderly is further established. Methods: the sampling range of middle-aged and elderly over 55 years old in Beijing was taken as the sampling range, and 361 valid samples (64.86 卤6.93 years old) were retained. The basic information, living habits, current medical history, medication history, falling history and exercise psychological state information were collected by questionnaire. Sensory neuromuscular function, posture stability control and response ability were collected by test. In the first part, the single factor and multivariate Logistic regression analysis were carried out to screen the sensitive indexes, taking the history of fall as dependent variable and the factors that might affect the fall as independent variables. In the second part, taking the number of falls in the middle-aged and the elderly as dependent variables, the multi-classification Logistic regression analysis and the best cut-off point of ROC curve are carried out in order to establish the evaluation grade. Results: 1. 33.80% of the people have fallen in the past year, of which 27.87% have fallen once, 29.51% have fallen twice, 42.62% have fallen 3 times or more. Screening sensitive indexes that can predict the risk of falls in the middle-aged and the elderly, and finally 11 variables entered the regression equation, including women (OR=2.472), osteoporosis (OR=1.938), fainting / dizziness (OR=1.734). The difference of active position angle of knee joint was large (OR=1.958), Romberg 30s open eyes C90 Area area (OR=1.998), selective response time length (OR=1.398), hip joint angle (OR=1.050) at the time of departure in gait. The large range of trunk activity (OR=1.076) and the large acceleration of pelvis (OR=1.545) at the time of landing were the risk factors of falls in the middle-aged and the elderly. 10% contrast visual acuity (OR=0.791) and Tandem C90 Angle (OR=0.995) were the protective factors for falls in the middle-aged and the elderly. When the standardized total probability was 51.174, the Jordan index was the highest in predicting the occurrence of a fall in the middle-aged and the elderly. The screening sensitivity and specificity were 85.3% and 31.5% respectively. When the standardized total probability was 54.437, the Jordan index was the highest in predicting the occurrence of two falls in the middle-aged and the elderly. The screening sensitivity and specificity were 61.5% and 53.1%, respectively. When the standardized total probability was 56.985, the Jordan index was the highest in predicting the occurrence of three falls in the middle-aged and the elderly, with a screening sensitivity of 50.0% and a specificity of 65.5%. Conclusion: 1. The sensitive indexes selected in this study have a good effect on predicting the risk of falls in the middle-aged and the elderly, and the influence of sensitive indicators on falls is different. From large to small: 10% visual acuity contrast sensitivity difference gender osteoporosis syncope / dizziness pelvis accelerated selection response when walking trunk sloshing amplitude large hip extension knee joint active position angle difference is large station The lateral wobble of the body is obvious at once. It is suggested that targeted fall prevention can be carried out for the middle-aged and the elderly. 2. Whether the middle-aged and the elderly suffer from osteoporosis, whether they have symptoms of fainting / dizziness, and whether 10% of the contrast vision is sensitive. Whether the selective response is sensitive and whether the hip joint extension is adequate during walking is very important for the occurrence of falls and the prediction of the degree of falls in the middle-aged and the elderly. 3. According to the fall risk index of the middle-aged and the elderly, the evaluation grade of predicting the risk of falling in the middle-aged and the elderly is as follows: 1 鈮，
本文编号：2485272
[Abstract]:Objective: to study the risk factors related to falls in the middle-aged and the elderly, to explore the correlation between each factor and the degree of falls, and to screen out the sensitive indexes that can predict the occurrence of falls. On this basis, the evaluation grade which can predict the risk of falls in the middle-aged and the elderly is further established. Methods: the sampling range of middle-aged and elderly over 55 years old in Beijing was taken as the sampling range, and 361 valid samples (64.86 卤6.93 years old) were retained. The basic information, living habits, current medical history, medication history, falling history and exercise psychological state information were collected by questionnaire. Sensory neuromuscular function, posture stability control and response ability were collected by test. In the first part, the single factor and multivariate Logistic regression analysis were carried out to screen the sensitive indexes, taking the history of fall as dependent variable and the factors that might affect the fall as independent variables. In the second part, taking the number of falls in the middle-aged and the elderly as dependent variables, the multi-classification Logistic regression analysis and the best cut-off point of ROC curve are carried out in order to establish the evaluation grade. Results: 1. 33.80% of the people have fallen in the past year, of which 27.87% have fallen once, 29.51% have fallen twice, 42.62% have fallen 3 times or more. Screening sensitive indexes that can predict the risk of falls in the middle-aged and the elderly, and finally 11 variables entered the regression equation, including women (OR=2.472), osteoporosis (OR=1.938), fainting / dizziness (OR=1.734). The difference of active position angle of knee joint was large (OR=1.958), Romberg 30s open eyes C90 Area area (OR=1.998), selective response time length (OR=1.398), hip joint angle (OR=1.050) at the time of departure in gait. The large range of trunk activity (OR=1.076) and the large acceleration of pelvis (OR=1.545) at the time of landing were the risk factors of falls in the middle-aged and the elderly. 10% contrast visual acuity (OR=0.791) and Tandem C90 Angle (OR=0.995) were the protective factors for falls in the middle-aged and the elderly. When the standardized total probability was 51.174, the Jordan index was the highest in predicting the occurrence of a fall in the middle-aged and the elderly. The screening sensitivity and specificity were 85.3% and 31.5% respectively. When the standardized total probability was 54.437, the Jordan index was the highest in predicting the occurrence of two falls in the middle-aged and the elderly. The screening sensitivity and specificity were 61.5% and 53.1%, respectively. When the standardized total probability was 56.985, the Jordan index was the highest in predicting the occurrence of three falls in the middle-aged and the elderly, with a screening sensitivity of 50.0% and a specificity of 65.5%. Conclusion: 1. The sensitive indexes selected in this study have a good effect on predicting the risk of falls in the middle-aged and the elderly, and the influence of sensitive indicators on falls is different. From large to small: 10% visual acuity contrast sensitivity difference gender osteoporosis syncope / dizziness pelvis accelerated selection response when walking trunk sloshing amplitude large hip extension knee joint active position angle difference is large station The lateral wobble of the body is obvious at once. It is suggested that targeted fall prevention can be carried out for the middle-aged and the elderly. 2. Whether the middle-aged and the elderly suffer from osteoporosis, whether they have symptoms of fainting / dizziness, and whether 10% of the contrast vision is sensitive. Whether the selective response is sensitive and whether the hip joint extension is adequate during walking is very important for the occurrence of falls and the prediction of the degree of falls in the middle-aged and the elderly. 3. According to the fall risk index of the middle-aged and the elderly, the evaluation grade of predicting the risk of falling in the middle-aged and the elderly is as follows: 1 鈮，
本文编号：2485272
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