A Mixed-Methods Study on the Current Status and Influencing Factors of Fear of Falling in Elderly Patients with Frailty
-
摘要:
目的 探讨老年衰弱患者跌倒恐惧现状并分析其影响因素。 方法 采用解释性混合研究设计，采取便利抽样法，选取2025年1月至2025年10月在云南省某三甲医院老年医学科住院的335例老年衰弱患者为调查对象。使用一般资料调查表、Morse平衡量表、焦虑自评量表、抑郁自评量表和修订版跌倒恐惧调查问卷进行调查，多元线性回归分析老年衰弱患者跌倒恐惧的影响因素。采用目的抽样对16位老年衰弱患者进行半结构型访谈并对访谈资料进行分析。 结果 老年衰弱患者跌倒恐惧得分为（42.88 ± 3.65）分，焦虑自评得分为（41.17 ± 10.83）分，抑郁自评得分为（44.21 ± 8.92）分。多元线性回归显示，性别、月收入、年龄、情感状况、每周运动次数、疾病种类、Morse评分和每日睡眠时间是老年衰弱患者跌倒恐惧的主要影响因素（P < 0.05）。质性研究提炼了4个主题：躯体衰弱和疾病发作的双重挑战、跌倒经历引起自我暗示、缺乏安全舒适的外部环境和信息理解不全面。整合结果显示量性与质性研究结果相互验证与补充。 结论 老年衰弱患者的跌倒恐惧处于中等偏高水平，跌倒恐惧水平受到个人和环境的共同作用，医护人员应为此类患者实施针对性的护理干预措施。 Abstract:Objective To explore the current status of fear of falling in elderly patients with debilitating diseases and analyze its influencing factors. Methods An explanatory mixed-methods design was adopted. Using convenience sampling, a total of 335 elderly debilitated patients hospitalized in the department of geriatrics a tertiary hospital in Yunnan Province from January 2025 to October 2025 were enrolled as participants. Data were collected using a general Information Questionnaire, the Morse Balance Scale, the Self-Rating Anxiety Scale, the Self-Rating Depression Scale and the Modified Fear of Falling Questionnaire. Multiple linear regression analysis was used to identify the influencing factors of Fear of Falling in elderly debilitated patients. Semi-structured interviews were conducted with 16 elderly debilitated patients by purposive sampling and the interview data were analyzed qualitatively. Results The mean score of fear of falling in frail elderly patients was 42.88 ± 3. 65. The mean scores of anxiety and depression were 41.17 ± 10. 83 and 44.21 ± 8. 92 respectively. Multiple linear regression showed that gender, monthly income, age, emotional status, weekly exercise frequency, number of disease types, Morse score and daily sleep duration were the main influencing factors of fear of falling in elderly debilitated patients （P < 0.05）. The qualitative study refined four themes: the dual challenges of physical frailty and disease onset, self-suggestion caused by the fall experience; lack of a safe and comfortable external environment; and incomplete understanding of information. The integrated results show that the quantitative and qualitative findings mutually validated and supplemented each other. Conclusion The level of fear of falling in elderly debilitated patients is moderately high, influenced by both individual and environmental factors. Healthcare providers should implement targeted nursing interventions for this population. -
Key words:
- Fear of falling /
- Frail elderly /
- Influencing factors /
- Mixed-methods study
-
表 1 影响老年衰弱患者跌倒恐惧的单因素分析（$ \bar x \pm s $，n = 320）
Table 1. Univariate analysis of factors influencing fear of falling in frail elderly patients（$ \bar x \pm s $，n = 320）
项目 n FFQ-R得分 t/F P 项目 n FFQ-R得分 t/F P 性别 情感状况 男 167 43.77 ± 3.77 4.701 < 0.001* 有配偶 281 41.54 ± 4.22 −2.468 0.014* 女 153 41.91 ± 3.25 无配偶 39 43.06 ± 3.53 民族 听力障碍 汉族 243 42.60 ± 3.63 −2.472 0.014* 是 106 42.10 ± 3.49 −2.700 0.007* 少数民族 77 43.77 ± 3.58 否 214 43.26 ± 3.67 居住类型 疾病种类 楼房（无电梯） 127 41.76 ± 3.53 −4.570 < 0.001* < 3种 172 43.53 ± 3.54 3.535 < 0.001* 楼房/平房（有电梯） 193 43.61 ± 3.55 ≥ 3种 148 42.11 ± 3.64 辅具 多重用药 是 122 42.81 ± 3.33 −0.256 0.798 是 97 43.09 ± 3.26 0.694 0.488 否 198 42.92 ± 3.84 否 233 42.78 ± 3.81 每周运动次数 每日睡眠时间（h） ≤ 3次 233 42.33 ± 3.35 −4.529 < 0.001* < 6 175 43.29 ± 3.34 −2.241 0.026* > 3次 87 44.34 ± 4.00 ≥ 6 145 42.38 ± 3.94 年龄（岁） 学历 60～70 113 42.15 ± 4.08 3.825 0.023* 小学及以下 127 42.57 ± 3.45 2.542 0.08 71～80 104 43.09 ± 3.30 初中 118 43.47 ± 3.80 > 80 103 43.47 ± 3.35 高中/中专及以上 75 42，47 ± 3.65 医保类型 居住情况 职工 206 42.88 ± 3.47 0.244 0.783 独居 25 41.96 ± 4.02 0.975 0.378 居民 111 42.84 ± 4.00 和家人住 285 42.94 ± 3.64 自费 3 44.33 ± 0.58 和保姆/他人住 10 43.50 ± 2.80 抑郁程度 Morse评分（分） 无抑郁 273 42.94 ± 3.71 0.661 0.517 低风险 71 42.23 ± 3.30 3.714 0.025* 轻度抑郁 37 42.78 ± 2.67 中风险 89 42.42 ± 3.28 中度抑郁 10 41.60 ± 4.84 高风险 160 43.43 ± 3.95 ADL评分（分） 职业 轻度依赖 98 42.47 ± 3.41 0.887 0.413 工人/农民 157 42.59 ± 3.56 1.118 0.328 中度依赖 87 43.07 ± 3.66 职业技术人员 136 43.07 ± 3.73 重度依赖 135 43.05 ± 3.97 其他 33 43.48 ± 3.71 月收入（千元） 近1年跌倒经历（次） < 3 62 41.52 ± 3.47 6.903 0.001* 0 207 42.49 ± 3.47 3.531 0.03* 3～5 233 43.09 ± 3.51 1 108 43.54 ± 3.94 > 5 25 44.32 ± 4.47 2～3 5 44.60 ± 1.81 焦虑程度 无焦虑 217 42.87 ± 3.66 0.272 0.762 轻度焦虑 81 42.77 ± 3.52 中度焦虑 22 43.41 ± 4.14 *P < 0.05。 
下载: 导出CSV
表 2 老年衰弱患者跌倒恐惧、焦虑和抑郁得分情况（$ \bar x \pm s $，n = 320）
Table 2. Scores of fear of falling，anxiety and depression in frail elderly patients（$ \bar x \pm s $，n = 320）
项目 总分 条目均分 FFQ-R 42.88 ± 3.65 2.86 ± 0.24 SAS 41.17 ± 10.83 2.21 ± 0.45 SDS 44.21 ± 8.92 2.06 ± 0.54
下载: 导出CSV
表 3 变量赋值表
Table 3. Variable assignment table
变量 赋值 年龄 以 < 70岁为参照，70～79岁、80岁及以上设置哑变量 性别 男 = 0，女 = 1 月收入 以 < 3000 元为参照，3000 ～5000 元、 >5000 = 3元设置哑变量情感状况 有配偶 = 0，无配偶 = 1 每周运动次数 ≤ 3次 = 0， > 3次 = 1 疾病种类 < 3种 = 0，≥ 3种 = 1 Morse平衡量表 原值输入 每日睡眠时间 < 6小时 = 0，≥ 6小时 = 1 FFQ-R 原值输入
下载: 导出CSV
表 4 老年衰弱患者跌倒恐惧多元线性回归分析
Table 4. Multiple linear regression analysis of fear of falling in frail elderly patients
项目 β SE β’ t P 常量 34.437 2.066 − 16.670 < 0.001** 性别 −1.178 0.362 −0.162 −3.251 0.001** 年龄 0.804 0.225 0.181 3.573 < 0.001** 月收入 1.269 0.372 0.177 3.413 0.001** 情感状况 1.759 0.545 0.158 3.226 0.001** 每周运动次数 1.537 0.439 0.188 3.505 0.001** 疾病种类 −0.883 0.361 0.121 −2.447 0.011* 每日睡眠时间 −1.215 0.357 −0.166 −3.401 0.001** Morse平衡量表 0.522 0.222 0.115 2.345 0.019* 注：R2 = 0.287，调整后R2 = 0.261，F = 11.251，*P < 0.05；**P < 0.001。
下载: 导出CSV
表 5 混合研究整合结果
Table 5. Integrated results of the mixed-methods study
量性结果 质性结果 整合结果推论 性别（β = -1.178，P = 0.001）
男性跌倒恐惧得分 > 女性− 量性结果补充质性结果 年龄（β = 0.804，P < 0.001） 主题：躯体衰弱和疾病发作的双重挑战
P7：“年龄上来之后，走路是晃幽幽的，我平常是用拐杖”量性结果与质性一致 月收入（β = 1.269，P = 0.001） − 量性结果补充质性结果 情感状况（β = 1.759，P = 0.001） − 量性结果补充质性结果 每周运动次数（β = 1.537，P = 0.001） − 量性结果补充质性结果 疾病种类（β = -0.883，P = 0.011） 主题：躯体衰弱和疾病发作的双重挑战
P1：“（病情）重的那几天一直躺在床上，不敢活动，特别害怕跌倒，这几天好多了，我自己可以活动”质性结果补充量性结果
质性结果中表现为疾病是否处于急性发病期每日睡眠时间（β = -1.215，P = 0.001） − 量性结果补充质性结果 跌倒风险（Morse平衡量表）（β = 0.522，P = 0.019） 主题：跌倒经历引起自我暗示
P4：“自从上次跌倒之后我就特别小心，为了预防再次跌倒，如果遇到滑或者陡的地方就绕开”质性结果补充量性结果
质性结果中表现为跌倒经历− 主题：缺乏安全舒适的外部环境
P6：“过红绿灯时最害怕跌倒，每次我都着急忙慌，还没走到路口灯就变红了”量性结果补充质性结果 − 主题4：信息理解不全面
P13：“我特别害怕跌倒，起床上厕所都要她（保姆）帮我。因为医生告诉我，我的降压药特别强效，吃了之后要注意动作改变时预防跌倒”。量性结果补充质性结果
下载: 导出CSV
-
[1] 杨舸. 我国“十四五”时期的人口变动及重大“转变”[J]. 北京工业大学学报(社会科学版), 2021, 21(1): 17-29. doi: 10.12120/bjutskxb202101017 [2] 吴淑婷, 徐伟豪, 林展翼. 老年心血管疾病患者衰弱干预最新研究进展[J]. 中华老年心脑血管病杂志, 2025, 27(8): 1110-1113. [3] 耿圆圆, 张薇, 周鼒, 等. 老年人衰弱的心理社会因素流行病学研究进展[J]. 中国老年学杂志, 2021, 41(8): 1752-1756. [4] 周越, 潘宇帆, 戴雨, 等. 基于COSMIN指南对中文版老年人跌倒恐惧评估工具的系统评价[J]. 中国循证医学杂志, 2024, 24(11): 1305-1311. [5] O’Caoimh R, Costello M, Small C, et al. Comparison of frailty screening instruments in the emergency department[J]. Int J Environ Res Public Health, 2019, 16(19): 3626. doi: 10.3390/ijerph16193626 [6] Sawa R, Doi T, Tsutsumimoto K, et al. Overlapping status of frailty and fear of falling: An elevated risk of incident disability in community-dwelling older adults[J]. Aging Clin Exp Res, 2023, 35(9): 1937-1944. doi: 10.1007/s40520-023-02474-z [7] 许琳, 严立群, 吴争艳. 老年骨质疏松性椎体压缩骨折患者认知衰弱现状及其与跌倒恐惧的关系[J]. 护理实践与研究, 2022, 19(18): 2741-2745. [8] Knoop V, Costenoble A, Vella Azzopardi R, et al. The operationalization of fatigue in frailty scales: A systematic review[J]. Ageing Res Rev, 2019, 53: 100911. doi: 10.1016/j.arr.2019.100911 [9] 方积乾, 陆盈. 现代医学统计学[M]. 北京: 人民卫生出版社, 2002. [10] Bower E S, Wetherell J L, Merz C C, et al. A new measure of fear of falling: Psychometric properties of the fear of falling questionnaire revised (FFQ-R)[J]. Int Psychogeriatr, 2015, 27(7): 1121-1133. doi: 10.1017/S1041610214001434 [11] 王蕾, 王颖, 鲁志卉, 等. 修订版跌倒恐惧问卷的汉化及信效度研究[J]. 护理研究, 2022, 36(7): 1134-1138. [12] Zung W W K. A rating instrument for anxiety disorders[J]. Psychosomatics, 1971, 12(6): 371-379. doi: 10.1016/S0033-3182(71)71479-0 [13] Zung W W K. A self-rating depression scale[J]. Arch Gen Psychiatry, 1965, 12(1): 63. doi: 10.1007/springerreference_184638 [14] Morse J M, Black C, Oberle K, et al. A prospective study to identify the fall-prone patient[J]. Soc Sci Med, 1989, 28(1): 81-86. doi: 10.1016/0277-9536(89)90309-2 [15] 林嘉琪, 吴桂丽. Morse跌倒风险评估量表的临床应用研究进展[J]. 护理学报, 2018, 25(13): 42-45. doi: 10.16460/j.issn1008-9969.2018.13.042 [16] de Souza L F, Canever J B, de Souza Moreira B, et al. Association between fear of falling and frailty in community-dwelling older adults: A systematic review[J]. Clin Interv Aging, 2022, 17: 129-140. doi: 10.2147/CIA.S328423 [17] Makino K, Lee S, Bae S, et al. Prospective associations of physical frailty with future falls and fear of falling: A 48-month cohort study[J]. Phys Ther, 2021, 101(6): pzab059. doi: 10.1093/ptj/pzab059 [18] Birhanie G, Melese H, Solomon G, et al. Fear of falling and associated factors among older people living in Bahir Dar City, Amhara, Ethiopia- a cross-sectional study[J]. BMC Geriatr, 2021, 21(1): 586. doi: 10.1186/s12877-021-02534-x [19] Merchant R A, Chen M Z, Wong B L L, et al. Relationship between fear of falling, fear-related activity restriction, frailty, and sarcopenia[J]. J Am Geriatr Soc, 2020, 68(11): 2602-2608. doi: 10.1111/jgs.16719 [20] Kumar A, Carpenter H, Morris R, et al. Which factors are associated with fear of falling in community-dwelling older people?[J]. Age Ageing, 2014, 43(1): 76-84. doi: 10.1093/ageing/aft154 [21] Su Q, Gao Y, Zhang J, et al. Prevalence of fear of falling and its association with physical function and fall history among senior citizens living in rural areas of China[J]. Front Public Health, 2021, 9: 766959. doi: 10.3389/fpubh.2021.766959 [22] Chen T Y, Lee S, Hsu K W, et al. Poor sleep health predicts the onset of a fear of falling among community-dwelling older adults[J]. Sleep Health, 2024, 10(1): 137-143. doi: 10.1016/j.sleh.2023.10.007 [23] Kakazu V A, Pinto R Z, Dokkedal-Silva V, et al. Does poor sleep quality and excessive daytime sleepiness influence fear of falling among older adults? A cross-sectional study[J]. Sleep Biol Rhythms, 2022, 20(2): 287-295. doi: 10.1007/s41105-021-00368-z [24] Makino K, Makizako H, Doi T, et al. Fear of falling and gait parameters in older adults with and without fall history[J]. Geriatr Gerontol Int, 2017, 17(12): 2455-2459. doi: 10.1111/ggi.13102 [25] De Roza J G, Ng D W L, Mathew B K, et al. Factors influencing fear of falling in community-dwelling older adults in Singapore: A cross-sectional study[J]. BMC Geriatr, 2022, 22(1): 186. doi: 10.1186/s12877-022-02883-1 [26] 邵梦琪, 谢中垚, 霍霞, 等. 基于扎根理论的老年人跌倒恐惧发生机制模型的构建[J]. 护理研究, 2025, 39(8): 1233-1240. doi: 10.12102/j.issn.1009-6493.2025.08.001 [27] Xiong W, Wang D, Ren W, et al. The global prevalence of and risk factors for fear of falling among older adults: A systematic review and meta-analysis[J]. BMC Geriatr, 2024, 24(1): 321. doi: 10.1186/s12877-024-04882-w [28] 郭亚芬, 周建伟, 陈秋蕾. 68例住院患者跌倒伤害的影响因素分析[J]. 当代护士(上旬刊), 2021, 28(4): 45-48. doi: 10.19791/j.cnki.1006-6411.2021.04.016 [29] 荆海燕, 梁碧娟, 罗玉奇, 等. 老年衰弱前期患者跌倒风险预防及管理的研究进展[J]. 中国老年保健医学, 2024, 22(6): 124-127. [30] Arias-Fernández L, Caballero F F, Yévenes-Briones H, et al. Association between multimorbidity and risk of falls and fear of falling among older adults: The mediation effect of physical function, use of sleeping pills, and pain relievers[J]. J Am Med Dir Assoc, 2024, 25(10): 105201. doi: 10.1016/j.jamda.2024.105201 [31] 陶圆佳, 程宇琪, 晏和智, 等. 老年抑郁障碍患者认知损害的影响因素[J]. 昆明医科大学学报, 2024, 45(6): 94-99. doi: 10.12259/j.issn.2095-610X.S20240612 [32] Sheng Y, Wang C, Wang Y, et al. An umbrella review of physical-activity therapy and cognitive behavioral therapy in reducing fear of falling among community-dwelling older adults: Insights on intervention intensity and duration[J]. Front Public Health, 2025, 12: 1498451. doi: 10.3389/fpubh.2024.1498451 [33] Drummond F M M, Lourenço R A, de Souza Lopes C. Incidence, persistence and risk factors of fear of falling in older adults: Cohort study (2008-2013) in Rio de Janeiro, Brazil[J]. Rev Saude Publica, 2020, 54: 56. doi: 10.11606/s1518-8787.2020054001939 [34] 刘玉文, 张丽梅, 王永丽, 等. 老年多学科团队服务对共病伴营养不良老年患者的疗效分析[J]. 昆明医科大学学报, 2024, 45(12): 81-87. doi: 10.12259/j.issn.2095-610X.S20241211 -
