Johansson Jonas, Nordström Anna, Nordström Peter
Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden; Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden.
J Am Med Dir Assoc. 2016 Jun 1;17(6):535-40. doi: 10.1016/j.jamda.2016.02.009. Epub 2016 Mar 19.
As 90% of fractures are caused by falls, and as fractures are more common in elderly women than in elderly men, a better understanding of potential sex differences in fall rates and underlying mechanisms is needed. The purpose of this study was to determine whether women are more prone than men to falling, and to evaluate whether the risk of falling is associated with variations in gait patterns.
DESIGN, SETTING, AND PARTICIPANTS: The cohort for this prospective observational study consisted of 1390 community-dwelling men and women aged 70 years, examined in a health survey between July 2012 and November 2014.
Gait patterns were measured using a computerized walkway system during normal-speed, fast-speed, and dual-task trials. Triaxial accelerometers were used to collect objective data on physical activity, and self-reported fall data were collected by telephone 6 and 12 months after examination. Incident low-energy falls were defined as unexpected events in which participants came to rest on the ground.
During the follow-up period, 148 study participants (88 women, 60 men; P = .01) reported falls. After adjusting for multiple confounders, including objective measures of physical activity, socioeconomic factors, cardiovascular disease, and cognitive function, the odds ratio for falling in women was 1.49 (95% confidence interval [CI] 1.02-2.19). Variations in gait pattern were significantly (20%-40%) increased in fallers compared with nonfallers during the dual-task trial for step width, step length, stride length, step time, stance time, stride velocity, and single support time (all P < .05). Furthermore, women showed 15% to 35% increased variability in all of these gait parameters during the dual-task trial compared with men (all P < .01).
In the present cohort, 70-year-old women were at greater risk of falls compared with their male counterparts. This increased risk was associated with increased variation in gait pattern during dual-task activities, and may contribute to women's greater fracture risk compared with men.
由于90%的骨折由跌倒所致，且骨折在老年女性中比在老年男性中更为常见，因此有必要更好地了解跌倒发生率及潜在机制方面的性别差异。本研究的目的是确定女性是否比男性更容易跌倒，并评估跌倒风险是否与步态模式的变化有关。
设计、地点和参与者：这项前瞻性观察性研究的队列由1390名年龄在70岁的社区居住男性和女性组成，于2012年7月至2014年11月期间在一项健康调查中接受检查。
在正常速度、快速和双任务试验期间，使用计算机化步道系统测量步态模式。使用三轴加速度计收集身体活动的客观数据，并在检查后6个月和12个月通过电话收集自我报告的跌倒数据。低能量跌倒事件定义为参与者意外摔倒在地的事件。
在随访期间，148名研究参与者（88名女性，60名男性；P = 0.01）报告了跌倒事件。在对包括身体活动的客观测量、社会经济因素、心血管疾病和认知功能等多个混杂因素进行调整后，女性跌倒的优势比为1.49（95%置信区间[CI] 1.02 - 2.19）。在双任务试验中，与未跌倒者相比，跌倒者的步宽、步长、步幅长度、步时、站立时间、步幅速度和单支撑时间的步态模式变化显著增加（20% - 40%）（所有P < 0.05）。此外，与男性相比，女性在双任务试验中所有这些步态参数的变异性增加了15%至35%（所有P < 0.01）。
在本队列中，70岁的女性比男性有更高的跌倒风险。这种增加的风险与双任务活动期间步态模式的变化增加有关，并且可能导致女性比男性有更高的骨折风险。
