老年綜合評估及干預在跌倒風險患者中的臨床應用
發(fā)布時間：2018-08-24 08:01
【摘要】：目的本研究通過在住院跌倒高風險老年患者的臨床治療中引入老年綜合評估(Comprehensive Geriatric Assessment,CGA)及干預,觀察CGA及干預在降低老年患者的跌倒風險、降低跌倒發(fā)生率、緩解老年患者的跌倒恐懼心理、改善平衡能力、提高患者生存質量等方面的作用,為推進CGA及干預在老年患者中的臨床應用提供依據(jù)。方法選取2015年10月至2016年9月就住于華北理工大學附屬醫(yī)院老年病科的年齡≥60歲的老年患者進行跌倒風險量表評估,將最終篩查出的224例跌倒評分等級為高風險的患者作為研究對象,采用隨機分組的方法分成干預組和對照組,每組患者112例,其中對照組男性48例,女性64例,平均年齡77.18±7.76歲;干預組男性51例,女性61例,平均年齡76.46±7.37歲。對入選患者進行兩次跌倒風險評估、平衡能力的評估、跌倒效能量表評估及生存質量評估,分別于入院2日內及干預3個月時完成,記錄各項評分結果。評估時同時采集患者的姓名、性別、年齡、婚姻狀況、職業(yè)、吸煙飲酒情況等一般個人資料,收集血糖、血脂、血壓、電解質、患病情況等醫(yī)學資料。對照組患者給予常規(guī)的住院診療、健康知識教育及常規(guī)的醫(yī)學護理,干預組在上述診療及護理措施的基礎上,實施老年綜合評估及干預的內容,患者出院后每2周進行電話隨訪1次,隨訪的內容主要為對干預措施的執(zhí)行情況、是否有新的需要干預的問題,干預執(zhí)行3個月后對干預組患者進行第二次CGA評估,詳細記錄兩次評估的結果。使用Excel 2013軟件建立數(shù)據(jù)庫,應用SPSS21.0統(tǒng)計學軟件進行統(tǒng)計數(shù)據(jù)分析,計數(shù)資料采用例數(shù)和百分比進行表示,兩組之間的比較采用X2檢驗;計量資料采用均數(shù)±標準差((?)±s)來表示,兩組間及組內比較采用t檢驗,認為P0.05為差異具有統(tǒng)計學意義。結果1兩組患者在性別、年齡、婚姻狀況、文化水平、吸煙、飲酒等基礎資料方面進行比較,差異無統(tǒng)計學意義(P0.05)。兩組的空腹血糖、血壓、總膽固醇、甘油三酯、低密度脂蛋白、高密度脂蛋白、尿酸、體重指數(shù)比較,差異無統(tǒng)計學意義(P0.05)。2兩組患者入院時的跌倒風險評分進行比較,差異無統(tǒng)計學意義(P0.05),提示兩組間具有可比性。研究結束后兩組患者跌倒風險評分與入院時比較均有所降低,干預組與對照組相比下降更明顯(P0.01)。3干預結束后兩組患者跌倒發(fā)生率比較,干預組跌倒的發(fā)生率明顯低于對照組,兩組差異具有統(tǒng)計學意義(P0.05)。4兩組患者平均住院日比較,干預組明顯低于對照組,差異具有統(tǒng)計學意義(P0.01)。5兩組患者入院時的BBS評分相比,差異無統(tǒng)計學意義(P0.05)。研究后兩組患者的評分與研究之前比較,均有所改善(P0.05),干預組較對照組明顯升高,差異具有統(tǒng)計學意義(P0.01)。6兩組患者入院時的MFES評分相比,差異無統(tǒng)計學意義(P0.05)。研究后兩組患者的評分較研究前均有所改善(P0.05),干預組與對照組相比升高更明顯,差異具有統(tǒng)計學意義(P0.01)。7兩組患者研究前生存質量各個方面的評分相比,差異無統(tǒng)計學意義(P0.05)。研究結束后,對照組僅在軀體疼痛、情感職能、社會功能及總分方面與研究前比較差異有統(tǒng)計學意義(P0.05),干預組生存質量各項評分較研究前均有所增加(P0.05),且與對照組相比增加更明顯,差異具有統(tǒng)計學意義(P0.05)。結論1老年綜合評估及干預應用于住院跌倒高風險的老年患者,可以有以下效果:1)降低患者的跌倒風險評分及跌倒發(fā)生率。2)改善患者的平衡能力、緩解患者的恐懼跌倒心理。3)降低患者的平均住院日。4)提高老年患者的生存質量。
[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.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473
本文編號：2200151
[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.
【學位授予單位】：華北理工大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R473
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