Harada Kazuhiro, Oka Koichiro, Shibata Ai, Kaburagi Hironobu, Nakamura Yoshio
Graduate School of Sport Sciences, Waseda University.
Nihon Koshu Eisei Zasshi. 2010 Aug;57(8):612-23.
Although a foot care program for long-term care prevention has been launched in Japan, few studies have examined its effectiveness. The purpose of the present investigation was to examine the association of foot problems with fall experience and fear of falling among Japanese community-dwelling elderly people.
The participants were 10,581 community-dwelling elderly people (75.2 +/- 5.6 years) and the study design was cross-sectional using a questionnaire. Self-reported tinea pedis, skin problems (inflammation, swelling, or discoloration), nail problems (thickening or deformities), impairment (in function or blood flow), regular foot care, and wearing of appropriate shoes were selected as parameters of foot problems and their care. Logistic regression analysis was conducted to examine whether these were related to fall experience (in the past 1 year) and fear of falling adjusted for age, the Tokyo Metropolitan institute of gerontology index of competence, medical conditions, and lower limb functions.
Forty-six percents of males and 39.0% of females reported at least one foot problem. After adjusting for covariates, tinea pedis (male: adjusted odds ratio = 1.37[95% confidence interval= 1.15-1.63], female: 1.29[1.08-1.53]), skin problems (male: 1.66[1.32-2.101, female: 1.37[1.13-1.66]), nail problems (male: 1.72[1.45-2.051, female: 1.48[1.26-1.74]), and functional impairment (male: 2.42[1.91-3.05], female: 1.66[1.36-2.04]) were significantly associated with fall experience. Also, each problem was negatively associated with fear of falling (tinea pedis[male: 1.37 [1.15-1.62], female: 1.25[1.07-1.47]], skin problems[male: 1.42[1.13-1.801, female: 1.62[1.34-2.00]], nail problems[male: 1.41[1.19-1.68], female: 1.46[1.25-1.70]], functional impairment [male: 2.05[1.61-2.60], female: 2.10[1.69-2.60]]). In addition, regular foot care (0.81[0.71-0.921) was a significant correlate of fear of falling in females.
These results imply that focusing on foot problems (i.e., tinea pedis, skin problems, nail problems, functional impairment) would be one of means for fall preventions. Well-designed prospective studies evaluating foot problems objectively are now needed to confirm the relationships indicated by this study.
尽管日本已启动一项预防长期护理的足部护理计划，但很少有研究考察其有效性。本调查的目的是研究日本社区居住老年人足部问题与跌倒经历及跌倒恐惧之间的关联。
研究对象为10581名社区居住老年人（75.2±5.6岁），采用问卷调查进行横断面研究。选择自我报告的足癣、皮肤问题（炎症、肿胀或变色）、指甲问题（增厚或畸形）、功能障碍（功能或血流方面）、定期足部护理以及是否穿着合适鞋子作为足部问题及其护理的参数。进行逻辑回归分析，以考察这些因素是否与跌倒经历（过去1年）以及在调整年龄、东京都老人综合研究所能力指数、健康状况和下肢功能后与跌倒恐惧相关。
46%的男性和39.0%的女性报告至少有一个足部问题。在调整协变量后，足癣（男性：调整优势比=1.37[95%置信区间=1.15 - 1.63]，女性：1.29[1.08 - 1.53]）、皮肤问题（男性：1.66[1.32 - 2.10]，女性：1.37[1.13 - 1.66]）、指甲问题（男性：1.72[1.45 - 2.05]，女性：1.48[1.26 - 1.74]）和功能障碍（男性：2.42[1.91 - 3.05]，女性：1.66[1.36 - 2.04]）与跌倒经历显著相关。此外，每个问题都与跌倒恐惧呈负相关（足癣[男性：1.37[1.15 - 1.62]，女性：1.25[1.07 - 1.47]]、皮肤问题[男性：1.42[1.13 - 1.80]，女性：1.62[1.34 - 2.00]]、指甲问题[男性：1.41[1.19 - 1.68]，女性：1.46[1.25 - 1.70]]、功能障碍[男性：2.05[1.61 - 2.60]，女性：2.10[1.69 - 2.60]]）。此外，定期足部护理（0.81[0.71 - 0.92]）是女性跌倒恐惧的一个显著相关因素。
这些结果表明，关注足部问题（即足癣、皮肤问题、指甲问题、功能障碍）可能是预防跌倒的方法之一。现在需要设计良好的前瞻性研究来客观评估足部问题，以证实本研究所示的关系。
