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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
-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
--【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
-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
-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
-Concept Map
--【Concept Map】Elderly Health Assessment(1)
--【Concept Map】Elderly Health Assessment(2)
-【Test】CHAPTER 2
-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
--【Documentary Recommendation】Depression:Out of the Shadows
-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
-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
-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
-5.4 Prevention of Adverse Drug Reactions in the Elderly
--Prevention of Adverse Drug Reactions in the Elderly
-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
-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
-6.3 Urinary Incontinence in the Elderly
--Urinary Incontinence in the Elderly
-6.4 Constipation in the Elderly
-6.5 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
-6.9 Elderly Delirium
-6.10 Elderly Frailty
--【Literature Recommendation】Frailty in elderly people/Frailty in older people
-6.11 Pneumonia in the Elderly
-6.12 Hypertension in the Elderly
--【Literature Recommendation】2018 Chinese Guidelines for Prevention and Treatment of Hypertension
-6.13 Stroke in the Elderly
-6.14 Stable Angina in the Elderly
--Stable Angina in the Elderly
-Concept Map
--【Concept Map】Nursing Care for the Elderly with Common Health Problems and Diseases
-【Test】CHAPTER 6
-7.1 Concept of Hospice Care
--【Website Recommendation】 Definition of Palliative Care,WHO
-7.2 Death Education
--【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
-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