Wolinsky F D, Johnson R J, Fitzgerald J F
Department of Medicine, Indiana University School of Medicine, Indianapolis 46202-2859.
Med Care. 1992 Jul;30(7):587-97. doi: 10.1097/00005650-199207000-00002.
In this study, data from the Longitudinal Study on Aging were used to prospectively assess the relationship between repetitive falling or falling only once in the year before baseline and changes in health status and the use of health services. Multiple and logistic regression were used to control for a variety of known covariates, in addition to the baseline values of the target outcomes. Repetitive falling was associated with decreased health status, measured by various activities of daily living and disability indices, at both 2- and 4-year follow-ups. One fall, however, was never associated with deteriorating health status. Similarly, repetitive falling was related to a decreased likelihood of visiting a physician (at the first follow-up, only), but to an increased likelihood of hospitalization, nursing home placement, and death (at both follow-ups). Falling just one time, however, was only associated with an increased likelihood of nursing home placement. Based on outcome trajectories, two subpopulations of repetitive fallers were identified. One subpopulation was consistent with the rapid deterioration hypothesized by the "spiral" response to falling, and includes about 35% of the repetitive fallers (i.e., those who die within 4 years of baseline). The other subpopulation was consistent with the initial decline and subsequent stabilization hypothesized by the "drop-stabilization" response.
在本研究中，利用老龄化纵向研究的数据，前瞻性地评估基线前一年内反复跌倒或仅跌倒一次与健康状况变化及医疗服务使用之间的关系。除目标结局的基线值外，还使用多元回归和逻辑回归来控制各种已知协变量。在2年和4年随访中，通过各种日常生活活动和残疾指数衡量，反复跌倒与健康状况下降相关。然而，仅跌倒一次从未与健康状况恶化相关。同样，反复跌倒与就诊可能性降低（仅在首次随访时）相关，但与住院、入住养老院和死亡可能性增加（在两次随访中）相关。然而，仅跌倒一次仅与入住养老院可能性增加相关。根据结局轨迹，确定了反复跌倒者的两个亚组。一个亚组与跌倒的“螺旋式”反应所假设的快速恶化一致，约占反复跌倒者的35%（即那些在基线后4年内死亡的人）。另一个亚组与“下降-稳定”反应所假设的初始下降和随后稳定一致。
