70例老年住院患者跌倒 危险因素分析

Analysis of Fall Risk Factors in 70 Elderly Inpatients

摘要: 目的：分析老年住院患者跌倒的危险因素及相关临床资料，为优化老年住院患者跌倒预防流程提供理论依据。方法：选取2020年6月至2023年6月湘西州某三级甲等综合医院通过HIS系统上报的70例60岁及以上老年住院患者跌倒不良事件，分析跌倒患者的疾病、跌倒史、跌倒时症状、陪护、服药情况及跌倒发生的时间与地点、跌倒风险评分等级、当班护士工作年限等。结果：老年跌倒患者疾病诊断前3位的有恶性肿瘤(24.3%)、神经系统疾病(18.6%)、骨/关节疾病(11.4%)；有跌倒史的老年患者占37.1%；大多数患者有陪护(84.3%)；Morse跌倒风险评估跌倒高危的比例为80%；当班护士职称为护士的最多(45.7%)；服用1种及以上跌倒高危药物的有71.4%，服用4种及以上药物的患者达71.4%；跌倒发生在晚夜班最多(76%)；跌倒地点以病房和卫生间最多，病房为52.9%、卫生间为32.9%；跌倒损伤以头面部为主(37.1%)，跌倒伤害无伤害为38.6%、轻度伤害为37.1%、中度伤害为20%、重度伤害为4.3%。结论：老年患者如厕前后体位变化、疾病因素、跌倒史、服用跌倒高危药物及多重用药、患者及陪护跌倒预防知识缺乏及依从性差、护士评估与宣教不足、护士安全意识薄弱等为主要跌倒因素。相关部门及跌倒工作小组应根据患者跌倒危险因素，采取针对性预防措施，优化跌倒预防流程，以期降低住院患者跌倒发生率及伤害率。

Abstract: Objective: To analyze the risk factors and related clinical data of falls among elderly inpatients, providing a theoretical basis for optimizing fall prevention processes among elderly inpatients. Methods: A total of 70 fall incidents involving elderly patients aged 60 years and older were selected from a tertiary general hospital in Xiangxi Prefecture between June 2020 and June 2023, based on reports submitted via the hospital information system (HIS). The analysis included patients’ medical conditions, history of falls, symptoms at the time of fall, presence of caregivers, medication use, timing and location of falls, fall risk assessment scores, and the work experience of the on-duty nurses. Results: The top three diagnoses among elderly fall patients were malignant tumors (24.3%), neurological disorders (18.6%), and musculoskeletal diseases (11.4%). Thirty-seven point one percent of patients had a prior history of falls; most (84.3%) had a caregiver present; 80% were classified as high-risk for falls according to the Morse Fall Scale; the majority of on-duty nurses held the title of registered nurse (45.7%); 71.4% were taking one or more high-risk medications, and 71.4% were taking four or more medications; falls occurred most frequently during evening and night shifts (76%); the most common locations were patient rooms (52.9%) and bathrooms (32.9%); head and facial injuries were the most common (37.1%), while 38.6% sustained no injury, 37.1% had minor injuries, 20% had moderate injuries, and 4.3% had severe injuries. Conclusion: Major contributing factors for falls among elderly patients include positional changes when using the toilet, underlying medical conditions, previous fall history, use of high-risk medications, polypharmacy, lack of fall prevention knowledge and poor compliance among patients and caregivers, insufficient nurse assessments and education, and weak safety awareness among nursing staff. Relevant departments and fall prevention teams should implement targeted preventive measures based on individual fall risk factors to optimize fall prevention protocols and reduce both the incidence and severity of falls among hospitalized elderly patients.