School of Medicine and Pharmacology, University of Western Australia, Fremantle Hospital, PO Box 480, Fremantle, Western Australia 6959, Australia.
Busselton Population Medical Research Institute, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
Age Ageing. 2015 Jul;44(4):687-90. doi: 10.1093/ageing/afv024. Epub 2015 Mar 3.
fear of falling is an important falls-related symptom that has received little attention in studies of falls risk in older adults with type 2 diabetes.
matched pairs of participants with diabetes or with normoglycaemia (n = 186 per group) recruited from a community-based survey underwent an assessment of fear of falling and associated falls risk factors. Multivariate methods examined associations between fear of falling and risk factors for history of recent falls.
compared with the normoglycaemic participants, those with diabetes had worse mobility (slow timed Up and Go test times: 16.2 versus 4.9%, P < 0.01), more fear of falling (24.2 versus 15.1%, P < 0.05) and more activity restriction from fear of falling (indoors: 14.0 versus 4.8%, P = 0.006), but there was no increase in reported recent falls. In the combined sample, a history of recent falls was negatively associated with fear-related limitation of outdoor activities (odds ratio (95% confidence interval): 0.30 (0.15-0.58), P < 0.001) and positively associated with age (1.65 (1.20-2.28) per 10-year increase, P = 0.002) and use of antidepressants (2.14 (1.02-4.50, P = 0.044). The frequency of falls in those with recurrent falls was negatively associated with measures of balance.
type 2 diabetes is associated with increased fear of falling and fear-associated activity restriction, and this modifies the risk of falls even in the face of increased falls risk factors including worse mobility. Future studies of falls in diabetes need to consider that fear of falling is an important modifier of the relationship between risk factors and falls.
对 2 型糖尿病老年患者而言，害怕跌倒属于重要的与跌倒相关的症状，但这一症状在跌倒风险研究中并未得到充分关注。
本研究从社区调查中匹配了患有 2 型糖尿病或血糖正常的参与者（每组 186 人），对他们进行了害怕跌倒及其相关跌倒风险因素的评估。多变量方法分析了害怕跌倒与近期跌倒史相关风险因素之间的关联。
与血糖正常的参与者相比，糖尿病患者的移动能力更差（计时起立行走测试时间较慢：16.2%比 4.9%，P<0.01），害怕跌倒的程度更高（24.2%比 15.1%，P<0.05），因害怕跌倒而活动受限的情况更严重（室内：14.0%比 4.8%，P=0.006），但报告的近期跌倒次数并无增加。在合并样本中，近期跌倒史与害怕相关的户外活动受限呈负相关（比值比（95%置信区间）：0.30（0.15-0.58），P<0.001），与年龄呈正相关（每增加 10 岁，1.65（1.20-2.28），P=0.002），与使用抗抑郁药呈正相关（2.14（1.02-4.50），P=0.044）。反复跌倒者的跌倒频率与平衡测量值呈负相关。
2 型糖尿病与害怕跌倒和害怕相关的活动受限有关，即使存在移动能力更差等更多的跌倒风险因素，这种情况也会改变跌倒风险。未来对糖尿病患者跌倒的研究需要考虑到害怕跌倒是风险因素与跌倒之间关系的一个重要调节因素。
