养老机构老年人跌倒风险综合评估工具的研制与检验  

Development of a Comprehensive Fall Risk Assessment Tool for Older People in Elderly Care Institutions and Its Test

作　　者：罗园 张华 王三香 张孟喜[5] 邓雨茜 冉海烨 刘佳欣 张毅 陈希 吴一波 赵丽萍[5] LUO Yuan;ZHANG Hua;WANG Sanxiang;ZHANG Mengxi;DENG Yuqian;RAN Haiye;LIU Jiaxin;ZHANGYi;CHEN Xi;WU Yibo;ZHAO Liping(School of Nursing,Capital Medical University,Beijing 100069,China;Xiangya Nursing School,Central South University,Changsha 410013,China;Department of Clinical Nursing Education,Changsha Elderly Rehabilitation Care Home,Changsha 410007,China;Hunan Armar Elderly Care Institution,Changsha 410011,China;Department of Nursing,the Second Xiangya Hospital of Central South University,Changsha 410011,China;Hunan Provincial Key Laboratory of Oral Health Research,Xiangya Dental Hospital of Central South University,Changsha 410000,China;School of Public Health,Peking University,Beijing 100191,China)

机构地区：[1]首都医科大学护理学院,北京市100069 [2]中南大学湘雅护理学院,湖南省长沙市410013 [3]长沙老年康复护理院护理部,湖南省长沙市410007 [4]湖南阿默养老服务有限公司,湖南省长沙市410011 [5]中南大学湘雅二医院临床护理教研室,湖南省长沙市410011 [6]湖南中南大学湘雅口腔医院口腔健康研究湖南省重点实验室,湖南省长沙市410000 [7]北京大学公共卫生学院,北京市100191

出　　处：《中国全科医学》2025年第4期491-498,共8页Chinese General Practice

基　　金：湖南省自然科学基金资助项目(2021JJ70068);2022年度湖南省标准化项目(2022-40);玉润健康研究基金支持项目。

摘　　要：背景我国自1999年宣布进入老龄化社会以来,人口老龄化程度日益严重,养老机构成为老年人养老热门选择,但跌倒问题频发且现有评估工具效果不佳。目的研制养老机构老年人跌倒风险综合评估工具并检验其信效度。方法2021年3—12月,通过文献回顾、半结构式访谈、2轮专家函询及预调查,形成量表初始条目,并在养老机构随机选择老年人和养老护理员进行调查。采用SPSS 26.0和AMOS 26.0软件进行信效度分析和评价,采用相关系数法、临界比值法、内部一致性分析及探索性因素分析进行条目分析和筛选,选用内在信度、分半信度、评定者间信度和同质性信度检验评估工具的信度,选用表面效度、内容效度、效标关联效度、结构效度和区分效度检验评估工具的效度,采用受试者工作特征曲线检验评估工具的预测能力。结果构建的评估工具包括3个子工具:(1)老年人跌倒风险评估量表;(2)老年人跌倒史风险追踪调查表;(3)老年人跌倒风险每日检查清单。老年人跌倒风险评估量表总Cronbach'sα系数为0.73,评定者间系数为0.85;探索性因子分析提取3个公因子,累识方差贡献率为57.95%;验证性因子模型拟合度参数中的卡方自由度比值(χ^(2)/df)、拟合优度指数(GFI)、调整后拟合优度指数(AGFI)、基于标准化适度指标(NFI)、比较拟合指数(CFI)、Tucker-Lewis系数(TLI)、近似误差均方根(RMSEA)分别为2.43、0.95、0.91、0.89、0.93、0.91、0.07,区分效度经验证存在统计学意义(P<0.001)。预测能力分析结果显示,以Morse跌倒评估表(MFS)≥55分为标准时,受试者工作特征曲线下面积(AUC)为0.87;以MFS≤25分为标准时,AUC为0.84。老年人跌倒史风险追踪调查表和老年人跌倒风险每日检查清单经专家和养老护理员的评价后,形成最终版本。结论本研究开发养老机构老年人跌倒风险综合评估工具,包含3个子量表,三者间相辅�Background Since China officially entered into an aging society in 1999,the issue of population aging has escalated significantly,leading to institutional care becoming a popular option for older people.However,falls among residents are a recurring problem,and the current assessment tools have shown limited effectiveness.Objective To construct a comprehensive fall risk assessment tool for older people in elderly care institutions and verify its reliability and validity.Methods From March to December 2021,the initial item pool of the tool was developed through a literature review,semi-structured interviews and 2 rounds of expert consultation and pre-investigation.Older people and nursing assistants in elderly care facilities were randomly selected to make a survey.SPSS 26.0 and AMOS 26.0 software were used to analyze and evaluate the reliability and validity of the assessment tool.The correlation coefficient method,critical ration,internal consistency test and exploratory factor analysis were used for item analysis and screening.The intrinsic reliability,split-half reliability,scores reliability and interitem consistency reliability were used to examine the reliability;face validity,content validity,criterion-related validity,contract validity and discriminant validity were used to examine the validity.Results The assessment tools included three subinstruments:(i)Fall risk assessment scale for older people;(ii)Fall record form for older people;(iii)Daily fall risk checklist for older people.The total Cronbach's alpha coefficient for sub-instrument(i)was 0.73 and the scorer reliability coefficient was 0.85;the exploratory factor analysis extracted three common factors with a cumulative variance contribution of 57.95%;the fit indices of the confirmatory factor model:Chi-square degrees of freedom ratio(χ^(2)/df),Goodness of fit index(GFI),adjusted goodness of fit index(AGFI),standardized moderate index(NFI),comparative fit index(CFI),Tucker-Lewis coefficient(TLI),approximation error(RMSEA)were 2.43,0.95,0.91,0.89,0.

关 键 词：意外跌倒 老年人 养老机构 风险评估 

分 类 号：R12[医药卫生—环境卫生学]