【摘要】：目的：本文對與中老年人跌倒相關的危險因素進行研究,探討各因素與跌倒的相關程度,從中篩選出能夠預測跌倒事件發(fā)生的敏感指標,并在此基礎上進一步建立能夠預測中老年人發(fā)生跌倒風險的評價等級。方法：將北京市55歲以上中老年人作為研究對象的抽樣范圍,最終保留361例有效樣本(64.86±6.93歲)。通過問卷采集受試者基本信息、生活習慣、現(xiàn)病史、服藥史、跌倒史和運動心理狀態(tài)信息。通過測試法采集感覺神經(jīng)肌肉功能、姿勢穩(wěn)定控制和反應能力等指標。第一部分以中老年人是否存在跌倒史為因變量,以可能影響其跌倒的各因素為自變量,進行單因素和多因素Logistic回歸分析,篩選敏感指標。第二部分以中老年人的跌倒次數(shù)為因變量,進行多分類Logistic回歸分析和求解ROC曲線的最佳截斷點,以建立評價等級。結果：1.本中有33.80%的人在過去一年中發(fā)生過跌倒,其中27.87%跌倒過1次,29.51%跌倒過2次,42.62%跌倒過3次或3次以上。2.篩選可以預測中老年人發(fā)生跌倒風險的敏感指標,最終有11個變量進入回歸方程,其中女性(OR=2.472)、骨質(zhì)疏松(OR=1.938)、昏厥/暈眩(OR=1.734)、膝關節(jié)主動位置覺角度差值大(OR=1.958)、Romberg 30s睜眼C90 Area面積大(OR=1.998)、選擇反應時問長(OR=1.398)、步態(tài)中離地時刻髖關節(jié)角度大(OR=1.050)、軀干活動范圍大(OR=1.076)、以及著地時刻骨盆加速度大(OR=1.545)均是中老年人發(fā)生跌倒的危險因素；而10%對比度視力(OR=0.791)和Tandem C90 Angle(OR=0.995)是中老年人發(fā)生跌倒的保護因素。3.當標準化總概率為51.174時,預測中老年人發(fā)生1次跌倒的約登指數(shù)最大,其篩檢敏感性為85.3%,特異性為31.5%；當標準化總概率為54.437時,預測中老年人發(fā)生2次跌倒的約登指數(shù)最大,其篩檢敏感性為61.5%,特異性為53.1%；當標準化總概率為56.985時,預測中老年人發(fā)生3次跌倒的約登指數(shù)最大,其篩檢敏感性為50.0%,特異性為65.5%。結論：1.本研究篩選出的敏感指標對中老年人發(fā)生跌倒風險的預測效果較好,且敏感指標對跌倒的影響程度各有不同,其由大到小為：10%視力對比敏感度差性別骨質(zhì)疏松昏厥/暈眩骨盆加速不穩(wěn)選擇反應時行走時軀干晃動幅度大行走時伸髖不充分膝關節(jié)主動位置覺角度差大站立時身體側向晃動明顯。提示可據(jù)此對中老年人開展有針對性的跌倒預防工作。2.中老年人是否患有骨質(zhì)疏松、是否曾出現(xiàn)昏厥\暈眩癥狀、10%對比度視力是否敏感、選擇反應是否靈敏以及行走時髖關節(jié)伸展是否充分對于中老年人跌倒的發(fā)生以及跌倒程度的預判至關重要。3.本研究根據(jù)中老年人發(fā)生跌倒的跌倒風險指數(shù),建立的預測中老年人發(fā)生跌倒風險評價等級為：1≤跌倒風險指數(shù)3,無跌倒風險；3≤跌倒風險指數(shù)6,低度跌倒風險；6≤跌倒風險指數(shù)9,中度跌倒風險；9≤跌倒風險指數(shù)≤10,高度跌倒風險。
[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 鹵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，

本文編號：2485272