Abstract:

Objective A cross-sectional survey on the postoperative home care status and barriers was conducted among elderly patients with osteoporotic fractures nationwide，in order to provide a basis for promoting the improvement of standardized home care for elderly patients with osteoporotic fractures. Methods From October to November 2023，a survey on the current situation and barriers of home environment protection was conducted among elderly patients with osteoporotic fractures in the orthopedic wards of 594 hospitals across 31 provinces （autonomous regions/municipalities directly under the central government） using a convenience sampling method. Results A total of 14，349 questionnaires were distributed，and 12，496 valid questionnaires were collected，resulting in an effective response rate of 87.09%. Among the patients，5，502 cases（44.03%） had implemented home-based prevention and treatment of osteoporosis before the fracture. 2 095（16.77%） of the patients experienced a subsequent fracture，of which 65.11% of the patients who experienced a subsequent fracture received medication intervention after the initial fracture，while 19.86% of the patients who experienced a subsequent fracture did not comply with the treatment for osteoporosis after the initial fracture. Additionally，77.66%（n=1 627/2 095） of the patients received community medical services after the initial fracture. Barriers to care factors in the home environment after fracture from the patient’s perspective presented the complexity of the social-ecological system model in 6 dimensions at 2 levels：micro（basic personal situation，physiological factors，psychological factors，and behavioural factors），and meso（social support factors，and healthcare worker factors）. Conclusion In the vast majority of elderly patients in China，before osteoporotic fracture，home-based measures to prevent osteoporosis have not been adequately implemented;after the initial osteoporotic fracture，the pathway of re-fracture prevention and management in the patient’s home environment is not yet complete and its popularity needs to be improved;the barriers to home care faced by elderly patients with osteoporotic fracture are complex. It is recommended to promote effective linkages among hospitals，community health centres and families to strengthen the closed-loop management of re-fracture prevention and management.

Key words: Osteoporosis, Osteoporotic Fractures, Aged, Home Care, Barriers, Nursing Care

摘要：

目的 调查老年骨质疏松性骨折患者居家环境防护现况并分析其障碍因素，为完善老年骨质疏松性骨折患者家庭照护规范提供依据。方法 2023年10月—11月，采用便利抽样的方法，在31个省（自治区、直辖市）选取594所医院骨科病区的14 349例老年骨质疏松性骨折患者开展居家环境防护现况及障碍因素调查。 结果 共发放14 349份问卷，回收有效问卷12 496份，有效问卷回收率为87.09%。5 502例（44.03%）患者在骨折前居家落实骨质疏松症防治;2 095例（16.77%）发生再骨折，其中65.11%的再骨折患者首次骨折后采用了药物干预，仍有19.86%的再骨折患者首次骨折后未依从骨质疏松症的治疗，另外首次骨折后77.66%的患者接受过社区卫生服务中心提供的健康服务。患者视角下骨折后家庭环境中的照护障碍因素呈现出复杂性，从微观（个人基本情况、生理因素、心理因素、行为因素）、中观（社会支持因素、医护工作者因素）2个层面和6个维度呈现。结论 骨质疏松性骨折前，大多数老年患者居家防范骨质疏松症的措施未能得到充分执行;初次骨质疏松性骨折后，患者居家环境下的再骨折预防和管理路径尚不够完整，且普及性有待提高;老年骨质疏松性骨折患者所面临的居家护理障碍因素较复杂。建议推动医院、社区卫生服务中心、家庭之间的有效联动，强化再骨折防治闭环管理。

关键词: 骨质疏松, 骨质疏松性骨折, 老年, 家庭照护, 障碍因素, 护理