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6.1.2 Risk Factors for Falls in the Elderly课程教案、知识点、字幕

由于老年人跌倒具有普遍性

伤害性和高成本的特征

跌倒防范成为全球研究热点之一

实践证明

运用正确的跌倒风险评估工具筛选高危人群

及早识别跌倒的高危因素

并给予护理干预

可以有效的减少老人跌倒的发生

目前

国内外已经有大量的

跌倒风险评估工具被研发 使用

比如Morse跌倒评估量表

Berg平衡量表

30秒椅子起立测试

4步平衡测试

托马斯跌倒风险评估工具

住院病人跌倒风险评估量表等

跌倒的风险工具

可以帮助医护人员快速的筛查

跌倒的高危人群

在护理过程中

我们还需要进一步的查找现存

或潜在的危险因素

方能为制定具体化 个性化的

跌倒预防措施提供依据

跌倒的原因分为

内在危险因素和

外在危险因素两大类

内在危险因素是主要来源于患者本身的因素

通常不易被察觉且不可逆转

需要仔细询问才能获知

包括生理因素 病理因素

药物因素和心理因素

生理方面

中枢神经系统 感觉系统老化

导致个体对周围环境感知能力下降

加上平衡能力减弱

步态不稳

骨骼肌肉系统结构

功能损害和退化等

增加跌倒的危险

病理方面

脑卒中

帕金森等神经系统疾病

直立性低血压

小血管缺血性病变等

心血管系统疾病

白内障 青光眼等

影响视力的眼部疾病

痴呆抑郁等认知心理疾病

也是引发跌倒的常见原因

其他如晕厥 惊厥

足部疾病及足或脚趾的畸形等

会导致神经反射时间延长

和步态紊乱

感染 肺炎 贫血

以及电解质平衡紊乱等

会导致机体的稳定能力受损

老年人泌尿系统疾病

或其他伴随尿频 尿急

尿失禁等症状的疾病

常使老年人如厕增加

或发生排尿性晕厥等

而增加跌倒的危险

而合并多种慢性病的

老年人跌倒危险性

高于普通老人

药物因素在跌倒的发生中

也有着重要作用

降压药 扩张血管药

降糖药 镇静剂 多巴胺类等

尤其是多重用药

容易产生药物副反应

引起运动或神经系统功能的改变

降低老人对跌倒的应激反应

导致老人跌倒发生率上升

另有研究表明抗抑郁药

抗惊厥类等精神类药物

会引起椎体外系反应

比如说急性的肌张力障碍

类帕金森症和迟发型运动障碍等有关

心理因素

多是由于老人过度担心跌倒引起的

常附带身体 社会等多方面的损害

往往造成心理疾病

最终影响生活质量

有研究表明

有跌倒史的老人二次跌倒的发生率很高

主要是因为曾经跌倒

产生恐惧心理

陷入因跌倒 丧失信心

减少活动 再次跌倒的恶性循环

与内在危险因素相比

外在危险因素则更容易控制

环境方面

室内灯光太暗或太亮 有眩光

地板过滑 门槛过高

浴缸过高 马桶或家具过低

过道有障碍物

楼梯台阶高度和宽度不合适

日常用品的放置不方便

室内地面积水

物品摆放位置突然变换等

然而

单独的环境危害不足以引起老人的跌倒

老人的身体状况

和暴露环境之间的相互作用显得更为重要

在环境中的障碍物面前

由于老人平衡能力下降

前庭稳定性降低

使其难以快速反应

从而导致跌倒事件

所以老人面对环境因素的危险下

需要伴有不同程度功能的丧失

才会发生跌倒

因此老人的功能缺失

才是跌倒的根本原因

而环境是重要的诱因

社会方面

老年人的教育和收入水平

卫生保健水平

享受社会服务和卫生服务的途径

室外环境的安全设计

以及老年人是否独居

与社会的交往和联系程度等

都会影响他们跌倒的发生

通过监测 调查或常规工作

收集老年人的跌倒信息

分析评估

并确定老年人跌倒的上述内外危险因素

而后

根据评估结果

积极开展预防老人跌倒的指导干预措施

这将有助于减少老年人跌倒的发生

减轻老年人跌倒所致伤害的严重程度

Gerontological Nursing课程列表:

CHAPTER 1: General Introduction to Geronological Nursing

-1.1 Human Life Expectancy and Age Classification of the Elderly

--Human Life Expectancy and Age Classification of the Elderly

--【Vedio Recommendation】 How do we measure life expectancy ?

-1.2 Population Aging

--Population Aging

--【Literature Recommendation】World Report on Ageing and Health: 2015

-1.3 Influence and Countermeasures of Population Aging

--Influence and Countermeasures of Population Aging

--【Literature Recommendation】World Population Ageing Highlights:2019

-1.4 Goals and Principles of Elderly Care

--Goals and Principles of Elderly Care

--【Book Recommendation】Evidence-Based Geriatric Nursing Protocols for Best Practice

-1.5 Theories Related to Elderly Care

--1.5.1 Personality Development Theory and Life Review

--1.5.2 Disengagement Theory and Activity Theory

--1.5.3 Self-efficacy and Chronic Disease Management

--【Vedio Recommendation】8 Stages of Development by Erik Erikson

--【Literature Recommendation】Activity Theory, Disengagement Theory, and Successful Aging

--【Book Recommendation】Self-Efficacy in Changing Societies

--【Literature Recommendation】Obstacles and Policies of the Social Capital Participates in the Combination of Medical Care and Pension: A Literature Review

-1.6 Elderly Support and Elderly Care

--1.6.1 Concepts of Elderly Healthcare, Elderly Support and Elderly Care

--1.6.2 Home-based Elderly Care Model

--1.6.3 Institutional Elderly Care Model

--1.6.4 Integrated Medical and Nursing Care Model

--【Vedio Recommendation】Day in the Life of Home Care

--【Website Recommendation】Official Website of the National Institutes of Health

-Concept Map

--【Concept Map】General Introduction to Geronological Nursing

-【Test】CHAPTER 1

-【Case Discussion】CHAPTER 1

CHAPTER 2: Elderly Health Assessment

-2.1 Aging Changes in the Elderly

--2.1.1 Aging of the Respiratory System

--2.1.2 Aging of the Cardiovascular System

--2.1.3 Aging of the Digestive System

--2.1.4 Aging of the Urinary System

--2.1.5 Aging of the Endocrine System

--2.1.6 Aging of the Motor System

--2.1.7 Aging of the Nervous System

--2.1.8 Aging of the Sensory System

--【Literature Recommendation】Exercise Attenuates the Major Hallmarks of Aging

--【Book Recommendation】Hazzard's Geriatric Medicine and Gerontology

-2.2 Comprehensive Health Assessment of the Elderly

--Comprehensive Health Assessment of the Elderly

--【Literature Recommendation】Instruments to evaluate mental well-being in old age: a systematic review

-2.3 Principles of Elderly Health Assessment

--Principles of Elderly Health Assessment

-2.4 Assessment of the Functional Status of the Elderly

--Assessment of the Functional Status of the Elderly

--【Literature Recommendation】The Lawton Instrumental Activities of Daily Living (IADL) Scale

-2.5 Assessment of Cognitive Function in the Elderly

--Assessment of Cognitive Function in the Elderly

-2.6 Assessment and Adjustment of the Living Environment for the Elderly

--Assessment and Adjustment of the Living Environment for the Elderly

--【Literature Recommendation】Age-friendliness of living environments from the older person’s viewpoint: development of the Age-friendly Environment Assessment Tool

-Concept Map

--【Concept Map】Elderly Health Assessment(1)

--【Concept Map】Elderly Health Assessment(2)

-【Test】CHAPTER 2

-【Case Discussion】CHAPTER 2

CHAPTER3: Elderly Mental Health and Mental Health care

-3.1 Overview of the Psychological Characteristics of the Elderly

--Overview of the Psychological Characteristics of the Elderly

-3.2 Influencing Factors of Psychological Changes in the Elderly

--Influencing Factors of Psychological Changes in the Elderly

-3.3 Common Psychological Issues and Their Management in the Elderly

--3.3.1 Common Psychological Issues and Their Management in the Elderly (1)

--3.3.2 Common Psychological Issues and Their Management in the Elderly (2)

--【Book Recommendation】Development Through the Lifespan

-3.4 Depression in the Elderly

--3.4.1 Overview of Depression in the Elderly

--3.4.2 Clinical Symptoms of Depression in the Elderly

--3.4.3 Caring for Elderly Patients with Depression

--【Website Recommendation】

--【Documentary Recommendation】Depression:Out of the Shadows

--【Literature Recommendation】Management of depression in older adults:A review depression in older people

-3.5 Elderly Patients with Dementia

--3.5.1 Identification of Dementia Symptoms in the Elderly

--3.5.2 Intelligence Rehabilitation of Elderly Patients with Dementia

--3.5.3 Safety Care of Elderly Patients with Dementia

--【Website Recommendation】The Global Voice on Demaentia

-Concept Map

--【Concept Map】Elderly Mental Health and Mental Health Care

-【Test】CHAPTER 3

-【Case Discussion】CHAPTER 3

CHAPTER4: Elderly Daily Care

-4.1 Precautions for Daily Care of the Elderly

--Precautions for Daily Care of the Elderly

-4.2 General Care of Elderly Skin

--4.2.1 Characteristics and General Care of Elderly Skin

--4.2.2 Skin Itching and Its Management in the Elderly

--【Website Recommendation】American Academy of Dermatology

-4.3 Clothing Hygiene for the Elderly

--Clothing Hygiene for the Elderly

--【Literature Recommendation】The Design Methods of Functional Clothing for the Elderly

-4.4 Dietary Care for the Elderly

--4.4.1 Nutritional Needs of the Elderly and Influencing Factors of these Needs

--4.4.2 Dietary Care for the Elderly

--【Book Recommendation】Nutrition Care of the Older Adult: a Handbook for Dietetics

--【Website Recommendation】Nutrition for older persons

-4.5 Sleep Guidance for the Elderly

--4.5.1 Sleep Characteristics of the Elderly

--4.5.2 Sleep Guidance for the Elderly

--【Book Recommendation】An Occupational Therapist's Guide to Sleep and Sleep Problems

--【Website Recommendation】American Academy of Sleep Medicine

-4.6 Exercises Guidance for the Elderly

--4.6.1 Evaluation of Exercise Intensity in the Elderly

--4.6.2 Precautions Elderly Undertaking Exercises

--【Website Recommendation】American College of Sport Medicine

--【Book Recommendation】Handbook of Activities for the Elderly

-Concept Map

--【Concept Map】Elderly Daily Care

-【Test】CHAPTER 4

-【Case Discussion】CHAPTER 4

CHAPTER5:Medication Safety and Care for the Elderly

-5.1 Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--Characteristics of Drug Metabolism and Pharmacodynamics in the Elderly

--【Website Recommendation】How Drugs Work In the Elderly

-5.2 Common Adverse Drug Reactions and Their Causes in the Elderly

--Common Adverse Drug Reactions and Their Causes in the Elderly

-5.3 The Principles of the Use of Medications in the Elderly

--The Principles of the Use of Medications in the Elderly

--【Literature Recommendation】The American Geriatrics Society 2015 Updated Beers Criteria for Potentially Inappropriate Medication Use in Older Adults

-5.4 Prevention of Adverse Drug Reactions in the Elderly

--Prevention of Adverse Drug Reactions in the Elderly

--【Literature Recommendation】Drug-related falls in older patients: implicated drugs, consequences, and possible prevention strategies

-5.5 Medication Compliance in the Elderly

--Medication Compliance in the Elderly

-Concept Map

--【Concept Map】Medication Safety and Care for the Elderly

-【Test】CHAPTER 5

-【Case Discussion】CHAPTER 5

CHAPTER6:Nursing Care for the Elderly with Common Health Problems and Diseases

-6.1 Falls in the Elderly

--6.1.1 Epidemiological Characteristics of Elderly Falls

--6.1.2 Risk Factors for Falls in the Elderly

--6.1.3 Prevention of Falls in the Elderly

--【Website Recommendation】CDC STEADI(Stopping Elderly Accidents, Deaths & Injuries Tool Kit)

-6.2 Dysphagia in the Elderly

--Dysphagia in the Elderly

-6.3 Urinary Incontinence in the Elderly

--Urinary Incontinence in the Elderly

-6.4 Constipation in the Elderly

--Constipation in the Elderly

--【Literature Recommendation】Chronic Constipation in the Elderly Patient: Updates in Evaluation and Management

-6.5 Dry Mouth in the Elderly

--Dry Mouth in the Elderly

--【Website Recommendation】Academy of Nutrition and Dietetics

-6.6 Elderly Nutritional Deficiencies

--Elderly Nutritional Deficiencies - emaciation

-6.7 Visual Impairment in the Elderly

--Visual Impairment in the Elderly

--【Website Recommendation】Senior Eye Exams

-6.8 Senile Deafness

--Senile Deafness

-6.9 Elderly Delirium

--Elderly Delirium

-6.10 Elderly Frailty

--Elderly Frailty

--【Literature Recommendation】Frailty in elderly people/Frailty in older people

-6.11 Pneumonia in the Elderly

--Pneumonia in the Elderly

-6.12 Hypertension in the Elderly

--Hypertension in the Elderly

--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension

-6.13 Stroke in the Elderly

--Stroke in the Elderly

-6.14 Stable Angina in the Elderly

--Stable Angina in the Elderly

--【Literature Recommendation】2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes

-Concept Map

--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases

-【Test】CHAPTER 6

-【Case Discussion】CHAPTER 6

CHAPTER7 Hospice Care for the Elderly

-7.1 Concept of Hospice Care

--Concept of Hospice Care

--【Website Recommendation】 Definition of Palliative Care,WHO

-7.2 Death Education

--7.2.1 Death Education (1)

--7.2.2 Death Education (2)

--【Book Recommendation】The Meaning of Death by Herman Feife

-7.3 Nursing for Pain in the Dying Elderly

--Nursing for Pain in the Dying Elderly

--【Journal Recommendation】

-7.4 Nursing for Major Bleeding in the Dying Elderly

--Nursing for Major Bleeding in the Dying Elderly

-7.5 Nursing for Delirium in the Dying Elderly

--Nursing for Delirium in the Dying Elderly

-7.6 Nursing for Dyspnea in the Dying Elderly

--Nursing for Dyspnea in the Dying Elderly

--【Website Recommendation】The Hospice and Palliative Nurses Association,HPNA

-7.7 Psychological Problems and Nursing in the Dying Elderly

--Psychological Problems and Nursing in the Dying Elderly

--【Book Recommendation】On Death and Dying ,by Elisabeth Kübler-Ross

-7.8 Grief Counseling for the Widowed Elderly

--Grief Counseling for the Widowed Elderly

--【Book Recommendation】I Wasn't Ready to Say Goodbye,by Noel·Brook,Blair·Pamela

-Concept Map

--【Concept Map】Hospice Care for the Elderly

-【Test】CHAPTER 7

-【Case Discussion】CHAPTER 7

FINAL EXAM

-Final Exam

6.1.2 Risk Factors for Falls in the Elderly笔记与讨论

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