Background:Although fatigue has been shown to be strongly associated with falls risk, very few studies have focused on its mechanism involved in community-dwelling older subjects. The purpose of this study was to explore the relationship between fatigue and falls risk and its internal mechanism by constructing a chain mediation model.Methods:A cross-sectional study design was adopted. A convenience sample of 270 older adults was recruited from July to October 2021 in an urban community, in Beijing, China. The participants completed the 14-item Fatigue Scale (FS-14), Falls Efficacy Scale International (FES-I), the Short Physical Performance Battery (SPPB) and Fall-Risk Self-Assessment Questionnaire (FRQ) to measure fatigue, falls efficacy, lower limb function and falls risk. The theory of unpleasant symptoms was used as a conceptual framework. Structural equation modeling (SEM) was utilized to test the hypothetical model.Results:The overall fit of final model was found to be satisfactory: χ2/df = 1.61, CFI = 0.971, TLI = 0.962, RMSEA = 0.049 (95% CI 0.030/0.066) and SRMR = 0.023. Fatigue had a direct effect on falls risk (β = 0.559, S.E. = 0.089, 95% CI 0.380/0.731), and it also had indirect effects on falls risk (β = 0.303, S.E. = 0.072, 95% CI 0.173/0.460) through mediating factors. Falls efficacy and lower limb function were the main mediating variables, and there was a chain mediating effect (β = 0.015, S.E. = 0.010, 95% CI 0.003/0.046).Conclusions:Our study suggests that fatigue can influence falls risk among the elderly in China. There are many mediating paths between fatigue and falls risk. These results may help healthcare professionals to better understand the inherent relationship between fatigue and fall risk that may benefit older adults.

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 evaluate the sensitivity and specificity of the Geriatric Depression Scale-3-Apathy Subscale (GDS-3A) in the assessment of apathy in the aged by taking the Apathy Evaluation Scale-Clinician (AES-C) as a reference.Methods:From May 2019 to October 2020, convenience sampling was used to select 475 elderly patients who attended the Outpatient Department of the People's Liberation Army General Hospital and Hepingli Community Health Service Center in Dongcheng District, Beijing as the research object. The 15-item Geriatric Depression Scale (GDS-15) , GDS-12-Depression Subscale (GDS-12D) and the AES-C were used for investigation. The statistical analysis was conducted by using the correlation analysis and receiver operating characteristic (ROC) curve comparison analysis.Results:When GDS-3A selected 2 points as the boundary value, the corresponding sensitivity and specificity were 70.99% and 87.54%, respectively, and the area under the ROC curve was 0.77. GDS-3A was positively correlated with AES-C ( r=0.46, P<0.001) , GDS-12D ( r=0.67, P<0.001) , and GDS-15 ( r=0.87, P<0.001) . Conclusions:GDS-3A has high sensitivity and specificity, and can be used as a screening tool for large-scale epidemiological investigations or community elderly apathy manifestations.

跌倒是老年人伤害和死亡的第一大原因,且跌倒的发生以及其引起的一系列问题对个人、家庭和社会造成巨大的经济负担.而老年综合评估及干预是筛查和预防老年人跌倒的核心手段.文章围绕老年人跌倒预防,对国内外老年综合评估工具及干预措施研究现状进行了综述,以期为临床制订老年人相关跌倒预防策略提供参考.

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.

目的 探讨设置兼职护理岗位在医院护理人力资源管理中的实践效果.方法 护理部根据医院科室专业特点确定兼职岗位,采取岗位设置、岗位管理、使用管理等措施.结果 建立了医院兼职护士库,兼职护士高质量地完成了科室护理工作,兼职护士工作得到服务对象认可,服务满意度为96.67％,补充了护理人力.结论 在护理人员总体编制不增加的情况下,设置兼职护理岗位既确保了护理工作的顺利完成,同时优化了人力资源配置,有效利用了护理人力.