Sibley Kathryn M, Voth Jennifer, Munce Sarah E, Straus Sharon E, Jaglal Susan B
Toronto Rehabilitation Institute, University Health Network, Toronto, Canada.
BMC Geriatr. 2014 Feb 14;14:22. doi: 10.1186/1471-2318-14-22.
Falls and chronic disease are both important health issues in older adults. The objectives of this study were to quantify the prevalence of falls and multi-morbidity (≥2 chronic conditions) in Canadian older adults; examine associations between falls and number of chronic conditions; and explore whether certain patterns of chronic disease were associated with a greater risk of falling.
Data were derived from the Canadian Community Health Survey- Healthy Aging. Primary outcomes from 16,357 community-dwelling adults aged 65 years and over were self-reported falls in the previous 12 months and presence of 13 chronic conditions. Prevalence estimates were calculated with normalized sampling weights, and hierarchical cluster analysis was used to identify clusters based on chronic condition patterns, and tested for association to falls with logistic regression.
Overall prevalence of falling and multi-morbidity were 19.8% and 62.0% respectively. Fall risk was significantly greater in individuals with one, two, four, five and six or more chronic conditions relative to those with none (all p < 0.05). A seven-cluster model was selected, including groups with low prevalence of chronic disease, or high prevalence of hypertension and arthritis, visual impairment, hypertension, chronic obstructive pulmonary disease (COPD), diabetes, or heart disease and hypertension. Only the hypertension cluster (Odds Ratio [OR] = 1.2) and COPD cluster (OR = 1.6) were significantly associated with increased falls relative to the low prevalence group.
Both the number and pattern of chronic conditions were related to falls. COPD emerged as a significant predictor of falls despite affecting a smaller proportion of respondents. Continued study is warranted to verify this association and determine how to incorporate consideration of chronic disease and multi-morbidity into fall risk assessments.
跌倒和慢性病都是老年人重要的健康问题。本研究的目的是量化加拿大老年人跌倒和多重疾病（≥2种慢性病）的患病率；研究跌倒与慢性病数量之间的关联；并探讨某些慢性病模式是否与更高的跌倒风险相关。
数据来自加拿大社区健康调查-健康老龄化。16357名65岁及以上社区居住成年人的主要结局是过去12个月内自我报告的跌倒情况以及13种慢性病的患病情况。使用标准化抽样权重计算患病率估计值，并采用层次聚类分析根据慢性病模式识别聚类，并通过逻辑回归检验与跌倒的关联。
跌倒和多重疾病的总体患病率分别为19.8%和62.0%。与无慢性病的个体相比，患有1种、2种、4种、5种以及6种及以上慢性病的个体跌倒风险显著更高（所有p<0.05）。选择了一个七聚类模型，包括慢性病患病率低的组，或高血压和关节炎、视力障碍、高血压、慢性阻塞性肺疾病（COPD）、糖尿病，或心脏病和高血压患病率高的组。相对于低患病率组，只有高血压聚类（优势比[OR]=1.2）和COPD聚类（OR=1.6）与跌倒增加显著相关。
慢性病的数量和模式均与跌倒有关。尽管受影响的受访者比例较小，但COPD成为跌倒的一个重要预测因素。有必要继续进行研究以验证这种关联，并确定如何将慢性病和多重疾病的考虑纳入跌倒风险评估中。
