Service of Geriatric Medicine and Geriatric Rehabilitation, University of Lausanne Hospital Center, Lausanne, Switzerland.
Aging Clin Exp Res. 2010 Jun;22(3):212-8. doi: 10.1007/BF03324799. Epub 2009 Nov 27.
Falls efficacy has been shown to predict functional decline, but whether it is independently associated with frailty is still unclear. This study investigated the cross-sectional association between falls efficacy and the frailty phenotype in high-functioning older persons.
Subjects (n=861) were a sub-sample of community-dwelling persons aged 65 to 70 years enrolled in the "Lc65+" cohort, who had gait assessment. Data included demographics, functional, cognitive, affective and health status, as well as measures of physical performance. Falls efficacy was measured with the Falls Efficacy Scale-International (FES-I) and frailty with Fried's criteria. Participants were categorized into robust (no frailty criterion) and vulnerable (1 or more criteria). Low falls efficacy was defined as a FES-I score in the lowest quartile.
Overall, 23.9% of participants were vulnerable. Compared with robust participants, they were more likely to report low falls efficacy (43.3% vs 19.1%, p<0.001) and had poorer health and functional and mental status. They had slower gait speed (1.07+/-0.18 vs 1.15+/-0.15 m/s, p<0.001) and increased gait speed variability (coefficient of variation 4.10+/-4.03 vs 3.33+/-1.45%, p<0.001), although only 6 participants (0.7%) fulfilled Fried's slow walking criterion. In multivariate analysis, low falls efficacy remained associated with being vulnerable (adjusted OR 1.80, 95% CI 1.19-2.74, p=0.006), independent of comorbidity, functional status, falls history and gait performance.
In high-functioning older persons, low falls efficacy was associated with vulnerability, even after controlling for gait performance and falls history. Whether low falls efficacy is a potential target on the pathway leading to frailty should be further examined prospectively.
已证实跌倒效能可预测功能下降，但它是否与虚弱独立相关仍不清楚。本研究调查了高功能老年人中跌倒效能与虚弱表型的横断面关联。
受试者（n=861）是参加“Lc65+”队列的 65 至 70 岁社区居住者的亚样本，他们进行了步态评估。数据包括人口统计学、功能、认知、情感和健康状况，以及身体表现测量。跌倒效能用跌倒效能量表国际版（FES-I）和 Fried 标准测量。参与者分为强壮（无虚弱标准）和脆弱（1 个或更多标准）。低跌倒效能定义为 FES-I 评分处于最低四分位数。
总体而言，23.9%的参与者脆弱。与强壮参与者相比，他们更有可能报告低跌倒效能（43.3%比 19.1%，p<0.001），且健康状况和功能及心理状态更差。他们的步速较慢（1.07+/-0.18 比 1.15+/-0.15 m/s，p<0.001），步速变异性增加（变异系数 4.10+/-4.03 比 3.33+/-1.45%，p<0.001），尽管仅有 6 名参与者（0.7%）符合 Fried 缓慢行走标准。在多变量分析中，低跌倒效能与脆弱相关（调整后的 OR 1.80，95%CI 1.19-2.74，p=0.006），与合并症、功能状态、跌倒史和步态表现无关。
在高功能老年人中，即使控制了步态表现和跌倒史，低跌倒效能仍与脆弱相关。低跌倒效能是否是导致虚弱的潜在靶点，应进一步前瞻性研究。
