Page 66 - 2022-34-中国全科医学

http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn ·4287·

the elderly. Although China has carried out fall prevention programs sporadically，among which comprehensive fall prevention
programs centered on exercise intervention are rare，and there have been no investigations about the willingness of elderly people
at high risk of falls in the community to participate in comprehensive fall prevention programs. Objective To examine the
intention of community-living elderly residents at high risk of falls to participate in comprehensive fall-prevention programs，
and associated factors，providing a theoretical basis for the implementation of such programs. Methods By economic level and
geographical location，we selected three communities from Shanghai as research settings，namely，Tangqiao Community in
Pudong New Area（central urban area），Zhaoxiang Community in Qingpu District（outer suburb） and Gangyan Community
in Chongming County（outer suburb）. Elderly people aged 65 and above who participated in physical examinations in the
three communities from 2018 to 2019 were invited to attend a survey using a questionnaire consisting of demographics，FROP-
Com Screen，MFROP-Com Tool，self-designed fall risk questionnaire，Patient Health Questionnaire-9（PHQ-9），and
Generalized Anxiety Disorder scale（GAD-7）. Individuals with the FROP-Com Screen scale score >3 points were identified with
risk of falls，among whom those with total score of MFROP-Com Tool ≥ 11.5 points（high risk of falls） were included finally.
Results In total，318 cases were detected with high risk of falls，among whom 62（19.5%） thought falls were unpreventable.
Slippery floor〔73 respondents（23.0%）〕，inattention〔64 respondents（20.1%）〕and physical discomfort〔64 respondents（20.1%）〕
were reported to be the three leading causes of falls. Two hundred and fourteen（67.3%）were willing to participate in fall
prevention programs. The level of intention to participate in fall prevention programs differed significantly in the participants
according to living setting，educational level，use of a walker，self-assessed sleep quality，number of chronic diseases，foot
disease prevalence，exercise habits，history of falls in the past year，and cognition of whether falls can be prevented（P<0.05）.
Binary Logistic regression analysis showed that living in urban area〔OR（95%CI）=7.828（2.898，21.149）〕，having
an exercise habit〔OR（95%CI）=3.474（1.703，7.087）〕，previous history of falls〔OR（95%CI）=2.806（1.364，
5.773）〕，and having an idea of falls are preventable〔OR（95%CI）=4.124（1.749，9.726）〕 were associated with higher
level of intention to participate in an fall prevention program（P<0.05）. Conclusion In general，the community-living elderly
residents with high risk of falls had limited understanding of fall prevention，but most of them were willing to participate in fall
prevention programs. To promote the implementation of comprehensive fall prevention programs，it is necessary to improve their
awareness of fall prevention and enhance their willingness to participate.
【Key words】 Aged；Health services for the aged；Falls；Attitude to health；Root cause analysis

跌倒是我国≥ 75 岁老年人因伤致死的第一位 巷社区（远郊）、崇明区港沿社区（远郊）为调查地点，
原因 ［1］ ，给个人、家庭和社会带来了沉重的经济和照 对 2018—2019 年在 3 个社区接受健康体检的老年人进
护负担。国外数据显示，≥ 65 岁社区老年人中每年有 行问卷调查。纳入标准：（1）年龄≥ 65 岁；（2）在
28%~35% 会发生跌倒 ［2］ 。2020 年，我国第七次全国 本社区居住≥ 1 年；（3）知情同意，自愿参与本次研究。
人口普查资料显示，全国≥ 65 岁人口占比达 13.50%， 排除标准：存在认知功能障碍无法配合调查者。本研究
较 2010 年第六次普查的 8.87% 有明显上升 ［3］ 。随着 经中山医院伦理委员会审核并批准（审批号：B2017-
我国人口老龄化程度的进一步加深，老年人跌倒风险评 167R）。
估及跌倒高风险老年人的预防跌倒项目开展刻不容缓。 1.2 研究方法 本研究所用问卷由 6 部分组成：（1）
英国卫生部早在 2001 年就制定了老年人国家服务框架 基本情况调查表，包括姓名、居住地区、性别、年龄、
（national service framework，NSF）作为国家标准和指 婚姻状况、文化程度、助行器使用情况、睡眠质量自
导方针 ［4］ ，将跌倒的预防、治疗和管理确定为 NSF 的 评情况、运动爱好等。（2）跌倒风险初筛量表（Falls
优先议题之一。我国防跌倒项目虽有零星开展，但内容 Risk for Older People in the Community Screen，FROP-
较为单一，以运动干预为主要内容的综合性防跌倒项目 Com Screen），包括最近 1 年跌倒次数、日常生活是否
较少见，而针对社区跌倒高风险老年人综合性防跌倒项 需要帮助、观察行走或转身时是否有失去平衡的表现
目参与意愿的调查较为少见。本研究旨在了解跌倒高风 共 3 个条目。各条目分别赋值 0~3 分，总分 0~9 分。
险老年人参加综合性防跌倒项目的意愿，探究影响其意 FROP-Com Screen 评分 >3 分为有跌倒风险 ［5］ 。（3）
愿的因素，以期提升其参与意愿，为综合性防跌倒项目 修订版社区老年人跌倒风险评估工具（Modified Falls
的顺利实施提供依据。 Risk for Older People in the Community Tool，MFROP-Com
1 对象与方法 Tool），包括 13 个项目共 19 个条目，包括最近 1 年跌
1.1 研究对象 根据经济发展水平和地理位置，分别 倒次数和跌倒后损伤程度、所患影响自身平衡能力和灵
选取上海市浦东新区塘桥社区（中心城区）、青浦区赵 活性的疾病种数、较长期服用易致跌倒的药物种数、感