Older adults living in care facilities such as senior apartments may experience falls and severe falls (i.e., fall-related injuries or falls ≥2 times), which are associated with multiple risk factors. However, there are few studies on falls among older adults in senior Chinese apartments. The purpose of our study is to investigate the current situation of falls among older adults in senior apartments and analyze the related factors of falls and severe falls, to assist agency workers in identifying older adults who are at high risk of falls and reducing fall occurrence and fall injuries.

目的 探讨农村老年人害怕跌倒与既往跌倒经历和躯体功能表现的相关性,为实施有效预防策略和实践提供借鉴.方法 2020年6-10月,便利抽样法选取在某二级医院体检中心参加老人年度免费体检项目的老年人1642名进行面对面调查,采集老年人的一般人口学资料、跌倒经历、躯体功能表现和害怕跌倒情况,比较不同跌倒经历和躯体功能状态对老年人害怕跌倒的影响.结果 12.85％的老年人害怕跌倒.是否害怕跌倒老年人在年龄、性别、合并疾病数量、近5年及1年跌倒史、跌倒次数、跌倒损伤程度、躯体功能表现上的差异均有统计学意义(均P<0.05).多因素分析显示,跌倒损伤程度(OR=1.483)、四阶段平衡测试得分(OR=0.702)和30 s起坐测试个数(OR=0.956)与老年人害怕跌倒具有独立关联(均P<0.05).结论 既往发生跌倒且跌倒损伤程度越高,平衡能力和下肢肌肉耐力不足,可能会增加老年人害怕跌倒的发生.应制定针对性措施预防老年人跌倒、降低跌倒损伤,提高躯体功能水平.

目的了解老年公寓高龄老年人跌倒现状,并分析其影响因素,为机构开展针对性跌倒风险管理提供依据.方法2021年3～5月,便利抽取北京市4家老年公寓中256名80岁及以上的老年人,对其一般资料、跌倒史、跌倒相关疾病诊断与症状、药物使用和活动障碍情况进行回顾性调查分析.结果 老年公寓高龄老年人跌倒发生率为47.26％,其中女性跌倒发生率为53.02％,男性跌倒发生率为39.25％.logistic回归分析结果显示,女性(OR=2.110)、尿失禁/尿频(OR=1.945)、走路不稳(OR=4.112)是高龄老年人跌倒的高危因素(P＜0.05,P＜0.01).结论 老年公寓高龄老年人跌倒发生率高,且女性高于男性.女性、尿失禁/尿频、走路不稳的高龄老年人更易发生跌倒,应将该部分人群作为机构跌倒风险管理的切入点,实施针对性防跌倒干预.

Objective:To explore the effect of the application of nursing decision support information system in the continuing nursing of stroke patients in convalescent period, and to provide guidance for the information-based whole process nursing of stroke patients in convalescent period.Methods:A total of 107 stroke patients in convalescent period admitted to 4 Grade Ⅲ Level A hospitals of Beijing city from March to November 2019 were selected. The patients were divided into control group (53 cases) and test group (54 cases) by coin tossing method. The control group followed uniformly formulated discharge health education manual for post-discharge management and follow-up, while the test group received health guidance and follow-up through the nursing decision support information system. Barthel Index and MOS SF-36 were used to evaluate the activities of daily living and quality of life of the two groups of patients before intervention and 3 and 6 months after the intervention, and the results were compared.Results:There was no significant difference in Barthel Index before the intervention between the two groups( P>0.05). After 3 months of intervention, the Barthel Index ≤ 49, 50-70 and ≥ 71 in the test group were 7, 17 and 27 cases respectively, and 16, 21 and 13 cases in the control group respectively, and the difference between the two groups was statistically significant ( Z=-2.95, P<0.01). After 6 months of intervention, the Barthel Index ≤ 49, 50-70 and ≥ 71 in the test group were 7, 12 and 32 cases respectively, and 10, 15 and 25 cases in the control group respectively,and the difference between the two groups was statistically significant ( Z=-2.21, P<0.05). There was no significant difference in MOS SF-36 before the intervention between the two groups( P>0.05). After 3 and 6 months of intervention, the total score of MOS SF-36 in the test group was (50.51 ± 14.57), (57.06 ± 14.85) respectively, and that in the control group was (42.02 ± 15.48), (45.58 ± 14.97) respectively, and the differences between the two groups were statistically significant ( t=2.84, 3.23, both P<0.05). Conclusions:The application of nursing decision support information system can effectively improve the daily life ability of patients, enhance the quality of life of patients.

目的 构建并应用糖尿病自我管理决策辅助信息平台,提高患者血糖控制水平.方法 以糖尿病患者的需求为出发点,运用决策支持理论,设计和开发了糖尿病自我管理决策辅助信息平台,并在临床进行应用和评价.结果 开发的信息平台包含患者应用程序和医护网站2个部分,可实现实时记录、风险评测、在线学习、远程管理等功能.应用信息平台进行干预研究发现,观察组患者出院后12周的饮食及运动自我管理、血糖监测、足部护理行为以及血糖控制情况均明显优于对照组(均P<0.05).结论 糖尿病自我管理决策辅助信息平台功能设计科学、全面,实用性强,可以有效提高糖尿病患者的自我管理能力和血糖控制水平.

Objective:To evaluate the application value of simplified augmented reality (AR) technique in the location of puncture point before drainage of supratentorial hemorrhage in the elderly.Methods:One hundred and sixty-three senile patients with supratentorial cerebral hemorrhage (amount of bleeding: 30-60 mL) treated by hematoma drainage from February 2018 to February 2020 were chosen in our study; 85 patients (observation group) were treated with AR technique assisted drainage, and 78 patients (control group) accepted drainage assisted by virtual reality (VR) technique (3D slicer software) combined with AR technique (Sina software). The differences of preoperative location time, accuracy rate of catheter placement, sufficient drainage rate of hematoma within 72 h of surgery, postoperative pulmonary infection rate, postoperative Intensive Care Unit staying time, and favorable prognosis rate were compared between the two groups.Results:The accuracy of the catheter placement (95.3% vs. 94.9%), sufficient drainage rate of hematoma within 72 h of surgery (96.5% vs. 96.2%), postoperative pulmonary infection rate (21.2% vs. 19.2%), postoperative Intensive Care Unit staying time ([75.5±16.7] h vs. [81.5±19.5] h), favorable prognosis rate (75.3% vs. 70.5%) between the observation group and control group showed no significant differences ( P>0.05), but the preoperative location time in the observation group was significantly shorter than that in the control group ([12.2±6.5] min vs. [37.5±11.3] min, P<0.05). Conclusion:On the basis of no significant difference in the accuracy and therapeutic effect of catheter placement, drainage assisted by simplified AR technique is more convenient and faster than that by VR combined with AR technique.

Objective:To construct the evaluation index system of self-management quality for diabetic patients based on the information platform, so as to provide a reference for the development of diabetes management based on the information platform.Methods:From August to November 2018, the first draft of the index system was drawn up on the basis of literature review and expert meeting method. Through the Delphi method, two rounds of inquiries were conducted among 28 experts engaged in diabetes diagnosis and treatment, diabetes care, chronic disease management, nursing management, nursing education and so on, and the final index system was constructed. The activity and authority of experts, the consistency and coordination of experts' opinions were calculated.Results:The effective recovery rates of two rounds of consultation were 93.33% and 100.00%, and the expert authority coefficients were 0.911 and 0.945, respectively. In the second round of expert inquiry, the Kendall coordination coefficients of the first-level, second-level, and third-level indicators were 0.478, 0.478 and 0.537 respectively with statistical differences ( P<0.01) , and the coefficient of variation was all <0.25. The final evaluation index system of self-management quality for diabetic patients based on the information platform included 3 first-level indicators, 9 second-level indicators and 69 third-level indicators. Conclusions:The construction process of the evaluation index system of self-management quality for diabetic patients based on information platform is rigorous and scientific, and the indicator content is reasonable and reliable. It can provide a reference for perfecting the content of self-management intervention for diabetic patients supported by the information platform and improving the quality of comprehensive diabetes management.

目的 对比利用智能手机增强现实(augmented reality,AR)技术进行幕上脑出血引流术与传统立体定向引流术的手术时间与效果.方法 回顾性收集我院2018年2月至2020年2月我院老年幕上脑出血(出血量30～60 mL)引流手术治疗166例.其中研究组92例,为利用智能手机简化AR技术辅助立体定位血肿引流手术患者.对照组74例,为传统立体定向血肿引流手术患者.对比研究组与对照组患者手术时间、引流管位置准确率、血肿清除率、术后改良Rankin评分(modified Rankin scale,mRS)的差异,评价利用简化AR技术辅助定位引流术在幕上脑出血治疗中的应用价值.结果 研究组手术时间(42.5±7.7)min,对照组(109.4±7.3)min,两组比较差异有统计学意义(P<0.05).研究组和对照组置管准确率(94.6％vs.97.3％)、血肿清除率(87.3％±8.3％vs.89.5％±9.1％)、术后4周mRS(2.3±1.2 vs.2.2±1.3)、术后90 d随访Barthel(Barthel index,BI)明显改善率(76.1％vs.68.9％),两组比较差异无统计学意义(P>0.05).结论 利用智能手机简化AR技术辅助定位引流术治疗幕上脑出血,可明显缩短手术时间,无需专业设备、操作简便,并可取得与传统立体定向手术相同的疗效.

目的 探讨应用CT血管成像(CTA)点征选择老年基底节中等量脑出血超早期钻孔引流,或开颅手术治疗的手术方式.方法 选择2015年4月～2019年1月入住我院适合手术的老年中等量基底节脑出血(出血量30～60 ml)且家属同意超早期手术治疗患者216例,根据入院后患者是否同意行头颅CTA检查分为应用组(同意行CTA者)112例,对照组(不同意行CTA者)104例,应用组CTA点征阳性者,进入开颅亚组45例,CTA点征阴性者进入引流亚组67例.对照组根据患者家属选择的手术方式,分为开颅亚组46例,引流亚组58例.2组引流手术亚组超早期均给予微创血肿软通道引流术,并给予血肿内纤溶药物治疗.2组开颅亚组患者均给予超早期开颅血肿清除术治疗.对比应用组与对照组引流亚组及开颅亚组患者治疗效果的差异,评估应用CTA点征选择老年基底节中等量脑出血超早期手术方式的价值.结果 与对照组比较,应用组总有效率显著增高,差异有统计学意义(72.3％ vs 53.8％,P＜0.05).术后应用组血肿增大、死亡、颅内感染显著低于对照组(2.7％ vs 13.5％,3.6％vs 15.4％,1.8％ vs 7.7％,P＜0.05);术后对照组肺部感染与应用组比较差异无统计学意义(25.0％ vs 17.9％,P＞0.05).结论 通过CTA点征选择引流或开颅手术,可明显改善患者预后,CTA点征可作为客观指标是选择中等量基底节脑出血超早期手术方式.

目的 调查居家老年人跌倒效能的现状及影响因素,为制订跌倒干预措施提供依据.方法 便利抽样法抽取2019年1-12月在我院防跌倒多学科联合门诊就诊的老年人178例,采用修订版跌倒效能量表、中文版跌倒风险自评量表、计时起立-行走测试、30 s椅子坐立测试、四阶段平衡测试进行评价,并分析跌倒效能的影响因素.结果 居家老年人跌倒效能总分平均值为(102.57±29.361)分,得分最低的两个条目是"淋浴"和"上下楼梯",分别为(6.85±2.54)分和(6.30±2.67)分.年龄(B=-0.238,P=0.003)、文化程度(B=-0.168,P=0.022)、30 s椅子坐立测试结果(B=-0.208,P=0.010)是影响老年人跌倒效能的主要因素.结论 居家老年人跌倒效能呈中等水平,年龄越大、文化程度越高、平衡肌力越弱的老年人,跌倒效能越低,跌倒风险越高.

Objective:To explore the relationship between anxiety, depression and various dimensions of cognitive function in patients with mild cognitive impairment (MCI) .Methods:The convenient sampling method was adopted to conduct memory screening for 727 elderly people who visited the multidisciplinary joint memory clinic of a Class Ⅲ Grade A hospital in Beijing from January to December 2019. With their consent, 247 MCI patients were investigated using Montreal Cognitive Assessment (MoCA) , Generalized Anxiety Disorder (GAD-7) and Patient Health Questionnaire (PHQ-9) .Results:A total of 247 questionnaires were distributed and 233 valid questionnaires were returned. There were 67 cases (28.8%) of MCI patients with anxiety and depression, 11 cases (4.7%) with anxiety, 53 cases (22.7%) with depression and 102 cases (43.8%) without anxiety and depression. In MCI patients, anxiety was positively correlated with delayed recall ( P<0.05) , while depression was negatively correlated with language function ( P<0.05) . MCI patients with different emotional states had statistically significant differences in language function ( P<0.05) . Conclusions:MCI patients have a higher incidence of anxiety and depression, and anxiety and depression will affect different dimensions of cognitive function in MCI patients. Medical staff need to provide targeted interventions for MCI patients with different emotional characteristics.

为缓解社会老龄化压力和解决子女照顾老人的精力不足等问题,设计一种基于深度相机的高准确性和低误报性的人体跌倒检测系统.该系统使用RGB相机和红外IR相机获取标定后的老人所在环境的3D图像,并利用深度卷积神经网络提取人体的多个关节点位置,最后基于多个连续帧之间人体关节点的运动变化特征和3D场景特征相结合的方法综合判定老人是否发生跌倒行为.测试实验结果表明该系统能有效地检测到人体的跌倒行为,具有十分优良的鲁棒性.

Objective To explore the effect of telemonitoring and integrated management of blood pressure based on cloud platform on blood pressure variability in outpatients with hypertension. Methods A total of 172 hypertensive patients were selected from June to October 2016 and randomly divided into remote intervention group (84 cases) and control group (88 cases). In remote intervention group, the telemonitoring and integrated management of blood pressure based on cloud platform was applied including outpatient diagnostic assessment, remote blood pressure monitoring, remote health education and remote medical guidance;while in the control group, the routine outpatient follow-up practice was conducted. Three months later, the changes of morning blood pressure, control rate of morning blood pressure, circadian rhythm of blood pressure and standard deviation of blood pressure between two groups were compared. Results After intervention, the morning blood pressure decreased from (149.1±10.3) / (90.4±10.5) to (134.2±9.0) / (82.9±5.8) mm Hg and the number of the patients with morning blood pressure reached normal range increased from 6 (7.1％) to 46 (54.8％), while in the control group the morning blood pressure decreased from (149.4±15.0) / (90.0±12.4) to (141.6±10.2) / (87.0±5.7) mm Hg, the number of the patients with morning blood pressure reached normal range increased from 5 (5.7％) to 17 (19.3％) (all P<0.05).The patients with dipper blood pressure increased from 35 (41.7％) to 56 (66.7％) in remote intervention group, and from 38 (45.2％) to 42 (47.7％) in control group (P<0.05). After remote intervention, the standard deviation of 24 h, daytime and nighttime systolic blood pressure and diastolic blood pressure decreased, and extent of decrease was larger than control group (P<0.05).The 24 h, daytime and nighttime mean systolic blood pressure and diastolic blood pressure levels in remote intervention group were lower than that in control group (all P<0.05).Conclusion Compared to the traditional outpatient follow-up mode, blood pressure telemonitoring and integrated management can improve the control of blood pressure variability and decrease the morning blood pressure.

OBJECTIVES:To investigate establishing, applying and evaluating the fall prevention and control information system in elderly community.METHODS:Relying on internet technology and informatization means, the fall comprehensive prevention and control strategy of elderly was guided into online from offline. The fall prevention and control information system which was a collection of risk assessment, remote education and feedback was established. One hundred and twenty-six elderly (over 60 years old) in community were screened in this study and 84 high-risk elders who were involved in the remote continuous comprehensive intervention were screened out. Intervening measures included distributing propaganda album, making mission slides and video used to play with the interpretation remotely. Then fall related situation before and after intervention was analyzed and the effectiveness of system evaluated.RESULTS:After remote intervention, the fall incidence of high-risk group decreased from 21.43% to 4.76%(P<0.01). The body balance and gait stability improved clearly(P<0. 01). The rate of taking proper prevention and control behavior significantly improved(P<0.01). They believed in themselves not to fall down with more confidence when taking complex behaviors(P<0.01). The security of environment at home significantly enhanced(P<0. 01).CONCLUSIONS:Fall prevention and control information system in elderly community was innovative and convenient. The system could roundly assess the status related to fall and accurately screen out high-risk group. The system could implement the remote continuous comprehensive intervention so that the incident of fall was decrease. In conclusion, the system is stable and effective, can be further popularization and application as a successful pilot.

Objective To determine the effect of frailty on the prognosis in the elderly hypertensive patients.Methods A total of 314 elderly hypertension patients who visited the Outpatient Department or took physical examination in our hospital from March 2015 to October 2016 were enrolled in this study.Their general demographic characteristics and medical history were collected by question -naires.The comorbid conditions were evaluated with Charlson comorbidity index(CCI).Mini nutritional assessment-short form (MNA-SF)was used for nutritional assessment,and Barthel index for daily life ability.According to the state of weakness,they were divided into normal(n=65), pre-frialty(n =208)and frialty groups(n =41).Based on the occurrence of falls during the 18 months′follow-up,the patients were also assigned into fall group(n=41)and non-fall group(n=273), and into hospitalization group(n=133)and non-hospitalization group(n=181)according to all-cause hospitalization.SPSS statistics 19.0 was used for data processing.Student′s t test or Chi-square test was employed for intergroup comparison with different data types.The factors with signi-ficant difference by univariate analysis were further analyzed by multivariate logistic regression analysis to identify independent risk factors.Results Fried standard identified 41 frail patients out of the 314 subjects,with a detection rate of 13.1%,and the rate was increased with age.After adjustment, the regression model showed that pace reduction was associated with increased risk for fall (OR=2.88,95%CI 1.26-6.56,P<0.05),but not with all-cause hospitalization(OR=1.13,95%CI 0.57-2.22,P=0.726). Conclusion The prevalence of frailty in elderly hypertensive patients is increased with age.Pace reduction is an independent risk factor for incidence of fall in them.

目的 从美国引入老年人跌倒风险自评量表(Self-rated Fall Risk Questionnaire)形成相应的中文版,以期为我国老年人跌倒风险评估提供有效工具.方法 英文版量表经过翻译和文化调适形成中文版量表,抽取于2018年4-6月在本院防跌倒多学科联合门诊就诊的158例老年人进行问卷调查,评价量表的信度和效度.结果 参与调查的158例老年人中男性65例(41.1％),女性93例(58.9％),平均年龄为(71.14±7.89)岁;跌倒风险测评的平均得分为5.17±3.36.中文版老年人跌倒风险自评量表的重测信度为0.957,总量表的Cronbach's α系数为0.724.整个量表的内容效度指数为0.98.探索性因子分析提取的4个公因子累积方差贡献率为58.57％,且每个条目在其公因子上的载荷值均大于0.4.结论 中文版老年人跌倒风险自评量表测评简便,具有良好的信效度,可作为老年人跌倒风险筛查的测评工具.

Objective To explore the effect of cloud platform based blood pressure telemonitoring and comprehensive management on knowledge,attitudes,adherence and blood pressure control in outpatients with hypertension.Methods A total of 172 hypertensive patients attending an outpatient clinic were assigned into two groups according to their ID number:those with odd ID number were served as the observation group (84 cases) and received blood pressure telemonitoring and comprehensive management using the cloud platform,while those with even ID number were treated as the control group (88 cases)and were given routine outpatient follow-ups.Results After 3 months of intervention,the awareness rate of hypertension,attitudes/beliefs toward hypertension treatment,and adherence (except cigarette and alcohol use) in the observation group were significantly higher than the control group (P＜0.01 for all).Blood pressure control in the observation group was better than the control group (P＜0.01 for all).Conclusion Comparing to traditional outpatient follow-up,cloud platform driven blood pressure telemonitoring and comprehensive management have a better effect on knowledge,attitudes and adherence in patients with hypertension,thus to maintain blood pressure control.

Objective To explore hypertension patients' acceptability with the remote management model, and to provide a basis for clinical application in the future.Methods Totally 10 patients who received remote management between June and September 2016 were selected, and received unstructured interviews based on the technology acceptance model (TAM) with the phenomenological method in qualitative studies. And the data thus collected were analyzed and organized with the Colaizzi Seven-Step Method to find main themes. Results Totally 3 themes were found according to TAM, including perceived ease of use (the management platform was easy for use according to patients), perceived usefulness (patients better understood their own blood pressure, changed their habits of blood pressure monitoring and unhealthy lifestyle, improved treatment efficiency, and saved time costs), and intention of use (the participation of medical and nursing staffs could directly affect patients' intention of use, and patients had different opinions on expenses, believing that it was more meaningful to conduct remote management in short time and in particular cases).Conclusions Patients show a high acceptability with the remote management model, and in clinical application, further research is needed to tackle real difficulties and ensure the sustainable development of the model.

Objective To discuss the effect of the myodynamia training including the main muscle groups and weight-bearing joints of lower limbs on the balance and sports ability for elderly.Methods By convenience sampling,66 cadres' sanitarium elderly in Beijing were selected,and took myodynamia training for 12 weeks and compared the rate of fall,10m maximum walking speed,single leg balance test (SLBT) and timed "up and go" test (TUGT).Results After 12 weeks training,the incidence of falls from 24.24％ to 13.64％,the SLBT and maximum walking speed in high risk elderly were significantly changed (all P＜ 0.05).So was the finish time of TUGT in medium risk elderly (P＜0.05).Conclusion The myodynamia training of lower limbs can improve walking speed,enhance balance and sports ability and easy to understand,which is worth of promotion in elderly community.