老年脆性骨折患者日常生活能力影响因素分析^*

Analysis of influencing factors of daily living ability in elderly patients with fragility fractures

摘要

目的 观察老年脆性骨折患者骨折后第5年日常生活能力现状,分析影响因素。方法 针对2015—2016年大连医科大学附属第二医院骨科收治的775例老年脆性骨折患者进行回顾性分析。结合基础日常生活能力(BADL)量表和工具性日常生活能力(IADL)量表,通过电话对5年内425例生存患者进行评估和记录,采用多因素logistic回归模型对影响老年脆性骨折患者骨折后第5年BADL和IADL的影响因素进行分析。结果 5年内有效随访634例老年脆性骨折患者中,再次骨折103例(16.25%)、死亡209例(32.97%),425例生存患者中41例(9.65%)失能。骨折后第5年BADL所需帮助率为73.41%(312/425),需要帮助由高到低分别是:上下楼梯、洗澡、活动、床椅转移、穿衣、修饰、进食、如厕、控制大小便。IADL所需帮助率为73.88%(314/425),需要帮助由高到低依次为:使用车辆、购物、做家务、烹饪、财务管理、洗衣、服用药物、使用电话。BADL和IADL各项目所需帮助率较骨折前明显增加。对相关因素行logistic回归分析,发现年龄、脑血管疾病是BADL和IADL的共同危险因素(P＜0.05),骨折前BADL和IADL评分对BADL和IADL的恢复有一定促进作用(P＜0.05),而性别、首次骨折部位、药物治疗、再骨折未见明显差异(P＞0.05)。结论 老年脆性骨折患者5年内再骨折率、死亡率较高,生存患者第5年的BADL和IADL所需帮助率均较骨折前增加。年龄、脑血管疾病是阻碍骨折生存患者第5年日常生活能力恢复的影响因素,骨折前BADL和IADL评分较高有利于患者日常生活能力恢复。

Abstract

Objective To observe the status of daily living ability in elderly patients with fragility fracture in the fifth year after fracture, and to analyze the influencing factors. Methods A retrospective analysis was conducted on 775 elderly patients with fragility fractures admitted to the Orthopedics Department of the Second Affiliated Hospital of Dalian Medical University from 2015 to 2016. Among 425 cases surviving within 5 years, functional status was assessed using both the Basic Activities of Daily Living (BADL) scale and the Instrumental Activities of Daily Living (IADL) scale. Evaluate and record patients over the phone, and use a multiple logistic regression model to analyze the factors affecting ADL and IADL in elderly patients with fragility fractures at 5 years after fracture. Results Among 634 elderly patients with fragility fractures followed for 5 years, 103 (16.25%) experienced recurrent fractures, 209 (32.97%) died, and 41 (9.65%) of the 425 surviving patients became disabled. The rate of BADL assistance needed at the 5th year post-fracture was 73.41% (312/425), with the highest requirements in descending order: ascending/descending stairs, bathing, mobility, bed-to-chair transfer, dressing, grooming, eating, toileting, and controlling bowel/bladder movements. The assistance requirement rate for Instrumental Activities of Daily Living (IADL) was 73.88% (314/425). The activities requiring assistance, in descending order of frequency, were: using transportation, shopping, doing housework, cooking, managing finances, laundry, taking medications, and using the telephone.Comparing pre-fracture levels, the required assistance rates for each BADL and IADL item increased compared to pre-fracture levels 5 years later. Logistic analysis was conducted on relevant factors, and it was found that age and cerebrovascular disease were common risk factors for BADL and IADL (P<0.05). The pre-fracture BADL and IADL scores had a certain promoting effect on the recovery of BADL and IADL(P<0.05), while there were no significant differences in gender, first fracture site, drug treatment, and re-fracture(P>0.05). Conclusion Age and cerebrovascular disease are risk factors for BADL and IADL, The pre-fracture BADL and IADL scores have a certain promoting effect on the recovery of BADL and IADL.

关键词

脆性骨折 / 随访 / 基础日常生活能力 / 工具性日常生活能力

Key words

Fragility fracture / Follow-up / Basic activity of daily living / Instrument activity of daily living