Health Statistics and Geography Lab, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Shaw SH2-230, 55 Lake Avenue North, Worcester, MA, USA.
BMC Geriatr. 2013 Dec 6;13:133. doi: 10.1186/1471-2318-13-133.
Despite extensive research on risk factors associated with falling in older adults, and current fall prevention interventions focusing on modifiable risk factors, there is a lack of detailed accounts of sex differences in risk factors, circumstances and consequences of falls in the literature. We examined the circumstances, consequences and resulting injuries of indoor and outdoor falls according to sex in a population study of older adults.
Men and women 65 years and older (N = 743) were followed for fall events from the Maintenance of Balance, Independent Living, Intellect, and Zest in the Elderly (MOBILIZE) Boston prospective cohort study. Baseline measurements were collected by comprehensive clinical assessments, home visits and questionnaires. During the follow-up (median = 2.9 years), participants recorded daily fall occurrences on a monthly calendar, and fall circumstances were determined by a telephone interview. Falls were categorized by activity and place of falling. Circumstance-specific annualized fall rates were calculated and compared between men and women using negative binomial regression models.
Women had lower rates of outdoor falls overall (Crude Rate Ratio (RR): 0.72, 95% Confidence Interval (CI): 0.56-0.92), in locations of recreation (RR: 0.34, 95% CI: 0.17-0.70), during vigorous activity (RR: 0.38, 95% CI: 0.18-0.81) and on snowy or icy surfaces (RR: 0.55, 95% CI: 0.36-0.86) compared to men. Women and men did not differ significantly in their rates of falls outdoors on sidewalks, streets, and curbs, and during walking. Compared to men, women had greater fall rates in the kitchen (RR: 1.88, 95% CI: 1.04-3.40) and while performing household activities (RR: 3.68, 95% CI: 1.50-8.98). The injurious outdoor fall rates were equivalent in both sexes. Women's overall rate of injurious indoor falls was nearly twice that of men's (RR: 1.98, 95% CI: 1.44-2.72), especially in the kitchen (RR: 6.83, 95% CI: 2.05-22.79), their own home (RR: 1.84, 95% CI: 1.30-2.59) and another residential home (RR: 4.65, 95% CI: 1.05-20.66) or other buildings (RR: 2.29, 95% CI: 1.18-4.44).
Significant sex differences exist in the circumstances and injury potential when older adults fall indoors and outdoors, highlighting a need for focused prevention strategies for men and women.
尽管有大量研究探讨了与老年人跌倒相关的风险因素，以及目前针对可改变风险因素的跌倒预防干预措施，但文献中缺乏关于性别差异的跌倒风险因素、情况和后果的详细描述。我们在一项针对老年人的人群研究中，根据性别检查了室内和室外跌倒的情况、后果和由此产生的伤害。
年龄在 65 岁及以上的男性和女性（N=743）参与了维护平衡、独立生活、智力和老年人活力（MOBILIZE）波士顿前瞻性队列研究。通过全面的临床评估、家访和问卷调查收集基线测量数据。在随访期间（中位数=2.9 年），参与者每月在日历上记录每日跌倒发生情况，并通过电话访谈确定跌倒情况。根据活动和跌倒地点对跌倒进行分类。使用负二项回归模型计算特定情况的年化跌倒率，并比较男性和女性之间的差异。
总体而言，女性的户外跌倒率较低（粗率比（RR）：0.72，95%置信区间（CI）：0.56-0.92），在娱乐场所（RR：0.34，95%CI：0.17-0.70）、剧烈活动时（RR：0.38，95%CI：0.18-0.81）和雪地或冰面（RR：0.55，95%CI：0.36-0.86）跌倒的发生率低于男性。女性和男性在户外人行道、街道和路边以及行走时的跌倒率没有显著差异。与男性相比，女性在厨房（RR：1.88，95%CI：1.04-3.40）和进行家务活动时（RR：3.68，95%CI：1.50-8.98）的跌倒率更高。两性户外受伤跌倒率相当。女性的整体室内受伤跌倒率几乎是男性的两倍（RR：1.98，95%CI：1.44-2.72），尤其是在厨房（RR：6.83，95%CI：2.05-22.79）、自己的家（RR：1.84，95%CI：1.30-2.59）和另一个住宅（RR：4.65，95%CI：1.05-20.66）或其他建筑物（RR：2.29，95%CI：1.18-4.44）。
老年人室内外跌倒的情况和受伤潜在风险存在显著的性别差异，这凸显了针对男性和女性制定有针对性的预防策略的必要性。
