中風存活者跌倒的機率偏高


  Feb. 21, 2006(奧蘭多訊)-根據研究者於2006年國際中風會議中發表的研究結果,老年中風存活者跌倒的機率比沒有中風病史者高出兩倍,而在跌倒時受傷的機率高出三倍。
  
  主要作者Afshin A. Divani博士向Medscape表示,醫師必須了解中風存活者跌倒的機率高達36%,受傷的機率也是同樣的高,而這些事件將會影響這些病患的「復原」;我們必須量身訂做復健過程以避免跌倒的突發事件,以及改善這些病患復健時的生理與情緒復原狀況;在跌倒後,因為懼怕另外一次跌倒,病患通常會限制自己的活動;復健團隊可以透過評估病患的環境,以降低跌倒風險來突顯這個課題;Divani博士是紐阿克新澤西醫學院神經與神經科學部門Zeenat Qureshi中風研究中心主任。
  
  Divani與其同事採用2002年健康與退休研究(HRS),來決定中風病患跌倒的盛行率與頻率;HRS資料庫包括出生於1931年至1941年的病患,每2年根據他們的健康與經濟狀況進行面談。
  
  在2002年的調查中,17,92位病患接受訪談;這些病患中,1,273(7.07%)位表示他們有中風的病史;在調查的2年前,36%中風病患以及16%沒有中風的病患曾經跌倒一次(P<.05);這些病患中,14.1%中風存活者與5.5%沒有中風病史病患因為跌倒而受傷(P<.05);2.6%中風存活者以及0.9%沒有中風病史病患發生髖骨骨折(P<.05)。
  
  Edgar J. Kenton III醫師在面談中表示,我們需要教育神經學家們跌倒是個很重要的課題,同時必須密切地與物理治療及復健師合作,以突顯中風存活者跌倒的機率較高,且比較容易因此而受傷;Kenton醫師是中風預防/介入研究計畫的主任,該計畫由國家衛生研究院贊助,位於喬治亞州亞特蘭大Morehouse醫學院;Kenton醫師同時也是美國神經醫學會執業委員會主席,該委員會有針對病患安全的小組委員會。
  
  Kenton醫師表示,當中風病患求診時,我們一般都會將目光放在病患在緊急時發生的失語;然而,當他們轉移至復健時,如果病患跌倒,因為跌倒帶來的損傷與接下來因為損傷而受到阻礙的復健,復原的機會將會因而降低許多;我們知道要從中風復原與物理治療有關,因此,跌倒與預後有關,且會提高發病率。
  
  Kenton醫師附帶表示,醫師們應該對於不願意開始或是繼續物理治療的中風病患提高警覺;物理治療師通常會說,該名病患對於物理治療配合度不高;相對於將這些病患認為是配合度不好的病患,我們需要注意是否發生了什麼事情而影響了他們的意願;並不一定是發生骨折才會限制他們的意願,嚴重的扭傷與瘀青也可能有同樣的影響;相較於過去的老年病患,現在的老年病患活動力較高,因為他們想要恢復過去的日常生活,相對的跌倒的機會也會比較高了。

Stroke Survivors Face Increase

By Paula Moyer, MA
Medscape Medical News

Feb. 21, 2006 (Orlando) — Elderly people who have survived a stroke are twice as likely to fall as those with no stroke history, and they are 3 times as likely to be injured when they fall, according to investigators who presented their findings here at the 2006 International Stroke Conference.

"Doctors need to know that the incidence of falling in stroke survivors is high, 36%, as is their rate of injury, and that falls complicate survivors' recovery," principal investigator Afshin A. Divani, PhD, told Medscape. "We need to have a tailored rehabilitation process to prevent falling incidents in stroke patients and to promote their physical and emotional recovery when they do. After a fall, patients often limit their activities because they fear another fall. The rehabilitation team can address this issue by assessing the patient's environment for ways to reduce fall risks." Dr. Divani is the director of the Zeenat Qureshi Stroke Research Center in the department of neurology and neurosciences at New Jersey Medical School in Newark.

Dr. Divani and coinvestigators used data from the 2002 Health and Retirement Study (HRS) to determine the incidence and frequency of falling accidents among stroke patients. The HRS database consists of individuals born between 1931 and 1941 who are interviewed every 2 years about several aspects of their health and economic status.

In the 2002 survey, 17,992 participants responded. Of these, 1273 (7.07%) reported that they had a history of stroke. Within the 2 years prior to the survey, 36% of stroke patients and 16% of those with no stroke history had had a falling incident (P < .05). Of these, 14.1% of stroke survivors and 5.5% of those with no stroke history were injured by the fall (P < .05). Hip fracture occurred in 2.6% of stroke survivors and 0.9% of those without a history of stroke (P < .05).

"We need to educate neurologists that falls are a major issue," said Edgar J. Kenton III, MD, in an interview seeking outside comment. "We need to work closely with physical medicine and rehabilitation physicians to address stroke survivors' increased risk of falls and injury from them." Dr. Kenton is director of the Stroke Prevention/Intervention Research Program, a program funded by the National Institutes of Health and housed in the Morehouse School of Medicine in Atlanta, Georgia. Dr. Kenton, a professor of medicine at Morehouse, is also chair of the American Academy of Neurology Practice Committee, which has a subcommittee on patient safety.

"When patients come in with a stroke, we typically focus on dysphagia in the acute setting," hDr. Kenton said. "However, when they move on to rehabilitation, if patients have a fall, the chances of recovery are significantly reduced, because of the injury and the resultant delay of physical therapy. We know that recovery from stroke is linked to prompt institution of physical therapy. Therefore, falls are linked to reduced outcomes and a higher degree of morbidity."

Physicians should have a high index of suspicion of falls when stroke patients are reluctant to begin or continue physical therapy, Dr. Kenton added. "The physical therapist often will say, 'The patient is noncompliant with physical therapy,' " he said. "Instead of thinking it's an ornery patient who doesn't want physical therapy, we need to ask what else could be going on. Falls are limiting not only when there's a fracture; severe sprains and bruises can also restrict activities. With today's active elderly, they're more at risk of falls than before because they want to get back into their previous activities."

ISC 2006: Abstract 56. Presented February 17, 2006.

Reviewed by Marni Kelman, MSc

    
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