Hoffman Geoffrey J, Hays Ron D, Wallace Steven P, Shapiro Martin F, Yakusheva Olga, Ettner Susan L
*Department of Systems, Populations and Leadership, University of Michigan School of Nursing, Ann Arbor, MI †UCLA Division of General Internal Medicine and Health Services Research ‡Department of Community Health Sciences §Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA.
Med Care. 2017 Apr;55(4):371-378. doi: 10.1097/MLR.0000000000000677.
Falls and fall-related injuries (FRI) are common and costly occurrences among older adults living in the community, with increased risk for those with physical and cognitive limitations. Caregivers provide support for older adults with physical functioning limitations, which are associated with fall risk.
Using the 2004-2012 waves of the Health and Retirement Study, we examined whether receipt of low (0-13 weekly hours) and high levels (≥14 weekly hours) of informal care or any formal care is associated with lower risk of falls and FRIs among community-dwelling older adults. We additionally tested whether serious physical functioning (≥3 activities of daily living) or cognitive limitations moderated this relationship.
Caregiving receipt categories were jointly significant in predicting noninjurious falls (P=0.03) but not FRIs (P=0.30). High levels of informal care category (P=0.001) and formal care (P<0.001) had stronger associations with reduced fall risk relative to low levels of informal care. Among individuals with ≥3 activities of daily living, fall risks were reduced by 21% for those receiving high levels of informal care; additionally, FRIs were reduced by 42% and 58% for those receiving high levels of informal care and any formal care. High levels of informal care receipt were also associated with a 54% FRI risk reduction among the cognitively impaired.
Fall risk reductions among older adults occurred predominantly among those with significant physical and cognitive limitations. Accordingly, policy efforts involving fall prevention should target populations with increased physical functioning and cognitive limitations. They should also reduce financial barriers to informal and formal caregiving.
跌倒及与跌倒相关的伤害（FRI）在社区居住的老年人中很常见且代价高昂，身体和认知功能受限的老年人风险更高。照顾者为身体功能受限的老年人提供支持，而身体功能受限与跌倒风险相关。
利用2004 - 2012年健康与退休研究的数据，我们研究了接受低水平（每周0 - 13小时）和高水平（每周≥14小时）非正式照料或任何正式照料是否与社区居住的老年人跌倒和FRI风险降低相关。我们还测试了严重身体功能障碍（≥3项日常生活活动）或认知功能受限是否会调节这种关系。
照料接受类别在预测无伤害跌倒方面具有联合显著性（P = 0.03），但对FRI无显著性（P = 0.30）。相对于低水平非正式照料，高水平非正式照料类别（P = 0.001）和正式照料（P < 0.001）与降低跌倒风险的关联更强。在日常生活活动≥3项的个体中，接受高水平非正式照料的人跌倒风险降低了21%；此外，接受高水平非正式照料和任何正式照料的人FRI分别降低了42%和58%。接受高水平非正式照料也与认知障碍者FRI风险降低54%相关。
老年人跌倒风险降低主要发生在身体和认知功能严重受限的人群中。因此，涉及跌倒预防的政策措施应针对身体功能和认知功能受限增加的人群。这些措施还应减少非正式和正式照料的经济障碍。
