要介護者における転倒による重篤な外傷の発生頻度および特徴:～医療・介護を要する在宅患者の転倒に関する多施設共同前向き研究（J-FALLS）～

Abstract

【Objective】To determine the incidence and characteristics of serious fall-related injuries, such as fractures, in elderly patients under home nursing care.【Methods】A prospective cohort study with a one-year follow-up was conducted. A total of 1,415 outpatients under long-term care insurance were recruited from 43 hospitals in Japan. The annual incidence of fractures, injuries leading to hospitalization, and deaths due to falling using a fall diary, as well as the details of falls leading to injuries, were investigated. The condition of patients 6 months after the onset of serious injuries was also analyzed.【Results】Incidence of serious injuries (patients with serious injuries/ total patients × 100 %) was 6.6 % (n=94), 8.93/100 person-years. Incidence of fractures was 6.0 % (n=85), 8.08/100 person-years; injuries leading to hospitalization was 3.3 % (n=47), 4.47/100 person-years; and death was 0 %. Number of fracture regions was 21 in the upper extremities (annual incidence 1.5%), 19 in the vertebra (1.3 %), 16 in the ribs (1.1 %), and 14 in the hips (1.0%). Of all falls leading to serious injuries, 63 occurred indoors (67.0%), including 19 in the living room (20.2 %). Falls occurred most frequently during walking (39.4 %), followed by starting to walk (13.8 %) and standing up (13.8%). Falling mostly occurred due to loss of balance (66 %). Most frequent behavior leading to falling was excretion (14.9%), followed by picking up things (12.8%). Falls occurred mostly on wooden floors (27.7%), followed by concrete (18.1%). At 6 months after the onset of serious injuries, patients under home care accounted for 81.6 %, those hospitalized 13.8 %, and those under nursing home 4.6 %. Mobility and level of care required significantly worsened after onset of serious injuries (p ＜ 0.001).【Conclusions】Japanese patients under home nursing care had about a three-fold higher incidence of fall-related serious injuries than those of community-dwelling people. Mobility significantly worsened after the onset of serious injuries and 81.6 % of the injured were under home care. Language: ja