Mamikonian-Zarpas Ani, Laganá Luciana
Department of Psychology, California State University Northridge, 18111 Nordhoff Street, Northridge, 91330, California, USA.
J Aging Gerontol. 2015 Dec;3(1):8-16. doi: 10.12974/2309-6128.2015.03.01.2.
Functional status is often defined by cumulative scores across indices of independence in performing basic and instrumental activities of daily living (ADL/IADL), but little is known about the unique relationship of each daily activity item with the fall outcome. The purpose of this retrospective study was to examine the level of relative risk for a future fall associated with difficulty with performing various tasks of normal daily functioning among older adults who had fallen at least once in the past 12 months. The sample was comprised of community-dwelling individuals 70 years and older from the 1984-1990 Longitudinal Study of Aging by Kovar, Fitti, and Chyba (1992). Risk analysis was performed on individual items quantifying 6 ADLs and 7 IADLs, as well as 10 items related to mobility limitations. Within a subsample of 1,675 older adults with a history of at least one fall within the past year, the responses of individuals who reported multiple falls were compared to the responses of participants who had a single fall and reported 1) difficulty with walking and/or balance (FRAIL group, = 413) vs. 2) no difficulty with walking or dizziness (NDW+ND group, = 415). The items that had the strongest relationships and highest risk ratios for the FRAIL group (which had the highest probabilities for a future fall) included difficulty with: eating (73%); managing money (70%); biting or chewing food (66%); walking a quarter of a mile (65%); using fingers to grasp (65%); and dressing without help (65%). For the NDW+ND group, the most noteworthy items included difficulty with: bathing or showering (79%); managing money (77%); shopping for personal items (75%); walking up 10 steps without rest (72%); difficulty with walking a quarter of a mile (72%); and stooping/crouching/kneeling (70%). These findings suggest that individual items quantifying specific ADLs and IADLs have substantive relationships with the fall outcome among older adults who have difficulty with walking and balance, as well as among older individuals without dizziness or difficulty with walking. Furthermore, the examination of the relationships between items that are related to more challenging activities and the fall outcome revealed that higher functioning older adults who reported difficulty with the 6 items that yielded the highest risk ratios may also be at elevated risk for a fall.
功能状态通常由日常生活基本活动和工具性活动（ADL/IADL）独立性指标的累积得分来定义，但对于每项日常活动项目与跌倒结局之间的独特关系却知之甚少。这项回顾性研究的目的是，在过去12个月中至少跌倒过一次的老年人中，检查与正常日常功能的各种任务执行困难相关的未来跌倒相对风险水平。样本包括来自科瓦尔、菲蒂和奇巴（1992年）1984 - 1990年衰老纵向研究的70岁及以上社区居住个体。对量化6项ADL和7项IADL以及10项与行动受限相关项目的单个项目进行了风险分析。在过去一年中至少有一次跌倒史的1675名老年人的子样本中，将报告多次跌倒的个体的回答与单次跌倒且报告1）行走和/或平衡困难（虚弱组，n = 413）与2）行走或头晕无困难（NDW + ND组，n = 415）的参与者的回答进行了比较。与虚弱组（未来跌倒概率最高）关系最强且风险比最高的项目包括：进食困难（73%）；理财困难（70%）；咬或咀嚼食物困难（66%）；行走四分之一英里困难（65%）；用手指抓握困难（65%）；以及独立穿衣困难（65%）。对于NDW + ND组，最值得注意的项目包括：洗澡或淋浴困难（79%）；理财困难（77%）；购买个人物品困难（75%）；不休息走上10级台阶困难（72%）；行走四分之一英里困难（72%）；以及弯腰/蹲下/跪下困难（70%）。这些发现表明，量化特定ADL和IADL的单个项目与行走和平衡困难的老年人以及无头晕或行走困难的老年人的跌倒结局存在实质性关系。此外，对与更具挑战性活动相关项目与跌倒结局之间关系的检查表明，报告6项风险比最高项目有困难的功能较好的老年人跌倒风险也可能升高。
