Geriatric Medicine, Department of Internal Medicine and Clinical Nutrition, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Centre for Bone and Arthritis Research, Sahlgrenska Academy, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
J Am Geriatr Soc. 2016 Nov;64(11):2242-2250. doi: 10.1111/jgs.14439. Epub 2016 Sep 30.
OBJECTIVES: To investigate the role of a fall risk assessment, using the Downton Fall Risk Index (DFRI), in predicting fall-related injury, fall-related head injury and hip fracture, and death, in a large cohort of older women and men residing in Sweden. DESIGN: Cross sectional observational study. SETTING: Sweden. PARTICIPANTS: Older adults (mean age 82.4 ± 7.8) who had a fall risk assessment using the DFRI at baseline (N = 128,596). MEASUREMENTS: Information on all fall-related injuries, all fall-related head injuries and hip fractures, and all-cause mortality was collected from the Swedish Patient Register and Cause of Death Register. The predictive role of DFRI was calculated using Poisson regression models with age, sex, height, weight, and comorbidities as covariates, taking time to outcome or end of study into account. RESULTS: During a median follow-up of 253 days (interquartile range 90-402 days) (>80,000 patient-years), 15,299 participants had a fall-related injury, 2,864 a head injury, and 2,557 a hip fracture, and 23,307 died. High fall risk (DFRI ≥3) independently predicted fall-related injury (hazard ratio (HR) = 1.43, 95% confidence interval (CI) = 1.39-1.49), hip fracture (HR = 1.51, 95% CI =1.38-1.66), head injury (HR = 1.12, 95% CI = 1.03-1.22), and all-cause mortality (HR = 1.39, 95% CI = 1.35-1.43). DFRI more strongly predicted head injury (HR = 1.29, 95% CI = 1.21-1.36 vs HR = 1.08, 95% CI = 1.04-1.11) and hip fracture (HR = 1.41, 95% CI = 1.30-1.53 vs HR = 1.08, 95% CI = 1.05-1.11) in 70-year old men than in 90-year old women (P < .001). CONCLUSION: Fall risk assessment using DFRI independently predicts fall-related injury, fall-related head injury and hip fracture, and all-cause mortality in older men and women, indicating its clinical usefulness to identify individuals who would benefit from interventions.
目的：使用唐顿跌倒风险指数（DFRI）评估跌倒风险，以调查其在预测瑞典大量老年男女跌倒相关损伤、跌倒相关头部损伤和髋部骨折以及全因死亡率方面的作用。 设计：横断面观察性研究。 地点：瑞典。 参与者：在基线时接受 DFRI 跌倒风险评估的老年成年人（平均年龄 82.4±7.8 岁）（N=128596）。 测量方法：所有跌倒相关损伤、所有跌倒相关头部损伤和髋部骨折以及所有原因的死亡率均从瑞典患者登记处和死因登记处收集。考虑到时间到结果或研究结束，使用泊松回归模型计算 DFRI 的预测作用，该模型将年龄、性别、身高、体重和合并症作为协变量。 结果：在中位随访 253 天（四分位间距 90-402 天）（>80000 患者年）期间，15299 名参与者发生了跌倒相关损伤，2864 名发生了头部损伤，2557 名发生了髋部骨折，23307 名死亡。高跌倒风险（DFRI≥3）独立预测跌倒相关损伤（风险比（HR）=1.43，95%置信区间（CI）=1.39-1.49）、髋部骨折（HR=1.51，95%CI=1.38-1.66）、头部损伤（HR=1.12，95%CI=1.03-1.22）和全因死亡率（HR=1.39，95%CI=1.35-1.43）。DFRI 更强烈地预测头部损伤（HR=1.29，95%CI=1.21-1.36 与 HR=1.08，95%CI=1.04-1.11）和髋部骨折（HR=1.41，95%CI=1.30-1.53 与 HR=1.08，95%CI=1.05-1.11），在 70 岁男性中比在 90 岁女性中更明显（P<.001）。 结论：使用 DFRI 评估跌倒风险可独立预测老年男女跌倒相关损伤、跌倒相关头部损伤和髋部骨折以及全因死亡率，表明其在识别可能受益于干预措施的个体方面具有临床应用价值。
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