Ev içi düşme nedeniyle acil servise başvuran yaşlı hastaların retrospektif analizi
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Date
2023
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Journal ISSN
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Publisher
Kırıkkale Üniversitesi
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info:eu-repo/semantics/openAccess
Abstract
Giriş ve Amaç: Yaşlılık ya da yaşlanma, bir bireyin doğumundan ölümüne kadar olan zaman dilimi içerisinde biyolojik, fizyolojik, psikolojik ve sosyal açıdan değişime uğradığı geri dönülmez süreçtir. Bu süreçte meydana gelen olumsuz değişimler çeşitli hastalıkların veya travmaların ortaya çıkmasına, fiziki ve ruhsal yetersizliklerin gelişimine yol açar. Yaşlı bireyler travma oluşumuna karşı daha hassas olabildiği gibi gerçekleşen bir travmanın sonuçları da daha yıkıcıdır. Bu çalışmada ev içi düşmeye bağlı travma sonrası acil servise başvuran yaşlı hastalar incelendi ve elde edilen verilerle bilimsel literatüre katkıda bulunmak amaçlandı. Gereç ve Yöntem: Çalışma 01. Ocak. 2019 ve 31. Aralık. 2021 tarihleri arasında Kırıkkale Üniversitesi Tıp Fakültesi Acil Tıp Anabilim Dalına ev içi düşme nedeniyle başvuran yaşlı hastalar üzerinde retrospektif olarak yapıldı. Hastaların demografik özelikleri, düşmeye ait özellikler (düşme mekanizması, düşme nedeni, başvuru saati, tekrarlayan düşme öyküsü), acil servis takip ve tedavi süreci, klinik sonlanımları ve ortaya çıkan sağlık maliyetleri kaydedildi. Verilerin analizinde SPSS 21.0 programı kullanıldı. p<0.05 değeri istatistiksel olarak anlamlı kabul edildi. Bulgular: Çalışmaya 110 hasta dahil edilmiş olup, bunların %40 (n=44)'ı kadın, %60 (n=66)'ı erkek ve yaş ortalaması 75.85±6.98/yıl idi. Yaşlı bireylerin %64.6'sında birden fazla kronik hastalık bulunmakta olup, polifarmasi sıklığı %70 idi. En sık kullanılan üç ilaç grubu Antihipertansifler (%40.9), Antiaritmikler (%39.1) ve Antidiyabetikler (%35.5) şeklinde sıralanıyordu. Ev içi düşmeler sıklıkla günlük ev içi faaliyetler sırasında (%77.3) gerçekleşirken, en sık düşülen yer evin banyosu (%31.8) ve düşmeye en sık neden olan mekanizma "Takılma-Tökezlenme" (%28.2) idi. Düşme sonrası en sık yumuşak doku travması (%64.5) ve kemik kırıkları (%39.1) izlenirken, femur (%15.5) en sık kırılan kemikti. Hastaların %30'u Ortopedi, %10.9'u Nöroloji ile konsülte edilirken, birden fazla klinikle konsülte edilenlerin oranı %12.7 idi. Tekrarlayan düşmeler yaşlı bireylerin %20.9'unda izlendi. Tekrarlayan düşmeler ile yaş (r=0.416; p<0.001) ve polifarmasi (r=0.190; p=0.047) arasında pozitif korelasyon saptanırken, hastalara ait diğer değişkenlerle tekrarlayan düşmeler arasında ilişki saptanmadı. Ev içi düşme sonrası yatırılarak tedavi edilen hastaların oranı %40.9 olup, hastanede kalış süresi 69.12±156.48/saat ve ortalama tedavi maliyeti 6724.95±2800.62 TL idi. Sonuç: Yaşlı bireylerde ev içi düşmeler sıklıkla erkeklerde, günlük aktiviteler sırasında, takılma-tökezlenme sonucu ve banyoda gerçekleşmektedir. Yaş ilerledikçe ve kullanılan ilaç sayısı (polifarmasi) arttıkça tekrarlayan düşmelerin sayısı artar. Bu tarz düşmeler sıklıkla ortopedik komplikasyonlara neden olmakla birlikte, multidisipliner yaklaşım ve yatırılarak tedavi edilmesi gereken hastaların sayısı da azımsanmayacak düzeydedir. Yaşlı hastalarda ev içi düşmelerin önlenmesi ve sağlık harcamalarının azaltılabilmesi için koruyucu hekimlik faaliyetlerinin ve yaşlı bireylere yönelik eğitimlerin arttırılması ve ev içinde gerekli tedbirlerin alınarak güvenli yaşam ortamlarının sağlanması gereklidir.
Introduction and Aim: Old age or aging is an irreversible process involving biological, physiological, psychological, and social change in the period from the birth of the individual to its death. Deleterious changes occurring during this process can lead to the emergence of various diseases or traumas and the development of physical and mental difficulties disabilities. Elderly individuals may be more susceptible to trauma, and its consequences are more destructive. Elderly patients presenting to the emergency department following indoor fall-related trauma were examined in this study, performed for the purpose of contributing to the scientific literature through its findings. Materials and methods: The study was performed retrospectively with elderly patients presenting to the Kırıkkale University Medical Faculty Emergency Medicine Department due to indoor falls between 1 January, 2019, and 31 December, 2021. The patients' demographic characteristics, fall-related characteristics (the mechanism, the cause of the fall, time of presentation, and history of recurrent falls), emergency department follow-up and treatment, clinical outcomes, and resulting health costs were recorded. The data were analyzed on SPSS version 21.0 software. p values <0.05 were regarded as statistically significant. Results: One hundred ten patients with a mean age of 75.85±6.98/years were included in the study, 40% (n=44) of whom were women and 60% (n=66) men. More than one chronic disease was present in 64.5% of the elderly individuals, and the prevalence of polypharmacy was 70%. The three most frequently used drug groups were antihypertensives (40.9%), antiarrhythmics (39.1%), and antidiabetics (35.5%). Indoor falls often occurred during domestic activities (77.3%), the most frequent fall site was the bathroom (31.8%), and the most common mechanism was 'tripping-stumbling' (28.2). Soft tissue trauma (64.6%) and bone fractures (39.1%) were most frequent after falls, and the most commonly fractured bone was the femur (15.5%). Thirty percent of cases were consulted with the orthopedic department and 10.9% with the neurology department, while 12.7% were consulted with more than one department. Recurrent falls were observed in 20.9% of the elderly individuals. Recurrent falls were positively correlated with age (r=0.416; p<0.001) and polypharmacy (r=0.190; p=0.047), but no correlation was found with other patient variables. In addition, 40.9% of patients were hospitalized for treatment after in-home falls, the mean length of hospital stay was 69.12±156.48 hours, and the mean cost of treatment was 6724.95±2800.62 Turkish lira. Conclusion: Indoor falls in the elderly frequently occur in men, during daily activities, as a result of tripping-stumbling, and in the bathroom. The number of recurrent falls increases with age and the number of drugs used (polypharmacy). Although such falls frequently result in orthopedic complications, the numbers of patients requiring a multidisciplinary approach and hospitalization for treatment should also not be underestimated. Preventive medicine activities and training for elderly individuals should be stepped up, and safe living environments should be provided by adopting appropriate measures at home in order to prevent indoor falls among elderly patients and to reduce health spending.
Introduction and Aim: Old age or aging is an irreversible process involving biological, physiological, psychological, and social change in the period from the birth of the individual to its death. Deleterious changes occurring during this process can lead to the emergence of various diseases or traumas and the development of physical and mental difficulties disabilities. Elderly individuals may be more susceptible to trauma, and its consequences are more destructive. Elderly patients presenting to the emergency department following indoor fall-related trauma were examined in this study, performed for the purpose of contributing to the scientific literature through its findings. Materials and methods: The study was performed retrospectively with elderly patients presenting to the Kırıkkale University Medical Faculty Emergency Medicine Department due to indoor falls between 1 January, 2019, and 31 December, 2021. The patients' demographic characteristics, fall-related characteristics (the mechanism, the cause of the fall, time of presentation, and history of recurrent falls), emergency department follow-up and treatment, clinical outcomes, and resulting health costs were recorded. The data were analyzed on SPSS version 21.0 software. p values <0.05 were regarded as statistically significant. Results: One hundred ten patients with a mean age of 75.85±6.98/years were included in the study, 40% (n=44) of whom were women and 60% (n=66) men. More than one chronic disease was present in 64.5% of the elderly individuals, and the prevalence of polypharmacy was 70%. The three most frequently used drug groups were antihypertensives (40.9%), antiarrhythmics (39.1%), and antidiabetics (35.5%). Indoor falls often occurred during domestic activities (77.3%), the most frequent fall site was the bathroom (31.8%), and the most common mechanism was 'tripping-stumbling' (28.2). Soft tissue trauma (64.6%) and bone fractures (39.1%) were most frequent after falls, and the most commonly fractured bone was the femur (15.5%). Thirty percent of cases were consulted with the orthopedic department and 10.9% with the neurology department, while 12.7% were consulted with more than one department. Recurrent falls were observed in 20.9% of the elderly individuals. Recurrent falls were positively correlated with age (r=0.416; p<0.001) and polypharmacy (r=0.190; p=0.047), but no correlation was found with other patient variables. In addition, 40.9% of patients were hospitalized for treatment after in-home falls, the mean length of hospital stay was 69.12±156.48 hours, and the mean cost of treatment was 6724.95±2800.62 Turkish lira. Conclusion: Indoor falls in the elderly frequently occur in men, during daily activities, as a result of tripping-stumbling, and in the bathroom. The number of recurrent falls increases with age and the number of drugs used (polypharmacy). Although such falls frequently result in orthopedic complications, the numbers of patients requiring a multidisciplinary approach and hospitalization for treatment should also not be underestimated. Preventive medicine activities and training for elderly individuals should be stepped up, and safe living environments should be provided by adopting appropriate measures at home in order to prevent indoor falls among elderly patients and to reduce health spending.
Description
Tıp Fakültesi, Acil Tıp Ana Bilim Dalı
Keywords
Acil Tıp, Emergency Medicine
