Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
J Am Geriatr Soc. 2012 Mar;60(3):517-24. doi: 10.1111/j.1532-5415.2011.03834.x. Epub 2012 Jan 27.
To compare characteristics of indoor and outdoor recurrent fallers and explore some implications for clinical practice, in which a fall risk assessment for all recurrent fallers has been recommended.
Prospective cohort study.
Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly of Boston Study, a study of falls etiology in community-dwelling older individuals from randomly sampled households in the Boston, Massachusetts, area.
Seven hundred thirteen women and men, mostly aged 70 and older, with at least 1 year of follow-up.
Data at baseline and from an 18-month follow-up examination were collected by questionnaire and comprehensive clinic examination. During follow-up, participants recorded falls on daily calendars. A telephone interview queried location and circumstances of each fall.
One hundred forty-five participants reported recurrent falls (≥2) during the first year. Those who had fallen only outdoors had good health characteristics, whereas those who had fallen only indoors were generally in poor health. For instance, 25.5% of indoor-only recurrent fallers had gait speeds of slower than 0.6 m/s, compared with 2.9% of outdoor-only recurrent fallers; the respective percentages were 44.7% and 8.8% for Berg balance score less than 48. Recurrent indoor fallers generally had poor health characteristics regardless of their activity at the time of their falls, whereas recurrent outdoor fallers who fell during vigorous activity or walking were especially healthy. A report of any recurrent falls in the first year did not predict number of positive findings on a comprehensive or abbreviated fall risk assessment at the 18-month follow-up examination.
Characteristics of community-dwelling older people with recurrent indoor and outdoor falls are different. If confirmed, these results suggest that different types of fall risk assessment are needed for specific categories of recurrent fallers.
比较室内和室外复发性跌倒者的特征，并探讨一些对临床实践的启示，其中建议对所有复发性跌倒者进行跌倒风险评估。
前瞻性队列研究。
波士顿维持平衡、独立生活、智力和老年人研究，这是一项对马萨诸塞州波士顿地区随机抽样家庭中的社区居住老年人跌倒病因的研究。
713 名女性和男性，年龄大多在 70 岁以上，随访至少 1 年。
通过问卷和全面诊所检查收集基线和 18 个月随访检查的数据。在随访期间，参与者每天在日历上记录跌倒情况。电话访谈询问了每次跌倒的地点和情况。
145 名参与者在第一年报告了复发性跌倒（≥2 次）。仅在户外跌倒的人健康状况良好，而仅在室内跌倒的人健康状况一般较差。例如，25.5%的仅室内复发性跌倒者的步速低于 0.6 m/s，而仅户外复发性跌倒者的这一比例为 2.9%；Berg 平衡评分低于 48 的分别为 44.7%和 8.8%。无论他们跌倒时的活动如何，室内复发性跌倒者通常都有较差的健康特征，而在剧烈活动或行走时跌倒的室外复发性跌倒者则尤其健康。在第一年报告任何复发性跌倒并不能预测在 18 个月随访检查时全面或简化跌倒风险评估的阳性发现数量。
具有室内和室外复发性跌倒的社区居住老年人的特征不同。如果得到证实，这些结果表明需要针对特定类型的复发性跌倒者进行不同类型的跌倒风险评估。
