老年人的足部问题
Foot Problems in Older Adults .
作者信息
Muchna Amy, Najafi Bijan, Wendel Christopher S, Schwenk Michael, Armstrong David G, Mohler Jane
出版信息
J Am Podiatr Med Assoc. 2018 Mar;108(2):126-139. doi: 10.7547/15-186. Epub 2017 Aug 30.
BACKGROUND
Research on foot problems and frailty is sparse and could advance using wearable sensor-based measures of gait, balance, and physical activity (PA). This study examined the effect of foot problems on the likelihood of falls, frailty syndrome, motor performance, and PA in community-dwelling older adults.
METHODS
Arizona Frailty Cohort Study participants (community-dwelling adults aged ≥65 years without baseline cognitive deficit, severe movement disorders, or recent stroke) underwent Fried frailty and foot assessment. Gait, balance (bipedal eyes open and eyes closed), and spontaneous PA over 48 hours were measured using validated wearable sensor technologies.
RESULTS
Of 117 participants, 41 (35%) were nonfrail, 56 (48%) prefrail, and 20 (17%) frail. Prevalence of foot problems (pain, peripheral neuropathy, or deformity) increased significantly as frailty category worsened (any problem: 63% in nonfrail, 80% in prefrail [odds ratio (OR) = 2.0], and 95% in frail [OR = 8.3]; P = .03 for trend) due to associations between foot problems and both weakness and exhaustion. Foot problems were associated with fear of falling but not with fall history or incident falls over 6 months. Foot pain and peripheral neuropathy were associated with lower gait speed and stride length; increased double support time; increased mediolateral sway of center of mass during walking, age adjusted; decreased eyes open sway of center of mass and ankle during quiet standing, age adjusted; and lower percentage walking, percentage standing, and total steps per day.
CONCLUSIONS
Foot problems were associated with frailty level and decreased motor performance and PA. Wearable technology is a practical way to screen for deterioration in gait, balance, and PA that may be associated with foot problems. Routine assessment and management of foot problems could promote earlier intervention to retain motor performance and manage fear of falling in older adults, which may ultimately improve healthy aging and reduce risk of frailty.
背景
关于足部问题与身体虚弱的研究较为稀少，而基于可穿戴传感器的步态、平衡和身体活动（PA）测量方法可能会推动这方面的研究进展。本研究调查了足部问题对社区居住的老年人跌倒可能性、虚弱综合征、运动表现和身体活动的影响。
方法
亚利桑那虚弱队列研究的参与者（年龄≥65岁、无基线认知缺陷、严重运动障碍或近期中风的社区居住成年人）接受了弗里德虚弱评估和足部评估。使用经过验证的可穿戴传感器技术测量步态、平衡（双脚睁眼和闭眼）以及48小时内的自发身体活动。
结果
在117名参与者中，41人（35%）非虚弱，56人（48%）为虚弱前期，20人（17%）虚弱。随着虚弱类别加重，足部问题（疼痛、周围神经病变或畸形）的患病率显著增加（任何问题：非虚弱者中为63%，虚弱前期者中为80%[优势比（OR）=2.0]，虚弱者中为95%[OR = 8.3]；趋势P = 0.03），这是由于足部问题与虚弱和疲惫均有关联。足部问题与跌倒恐惧相关，但与跌倒史或6个月内的跌倒事件无关。足部疼痛和周围神经病变与较低的步态速度和步幅长度相关；双支撑时间增加；步行时经年龄调整后的质心中外侧摆动增加；安静站立时经年龄调整后的质心和脚踝睁眼摆动减少；以及每日步行百分比、站立百分比和总步数降低。
结论
足部问题与虚弱程度、运动表现下降和身体活动减少有关。可穿戴技术是筛查可能与足部问题相关的步态、平衡和身体活动恶化情况的实用方法。对足部问题进行常规评估和管理可以促进早期干预，以保持老年人的运动表现并管理跌倒恐惧，这最终可能改善健康老龄化并降低虚弱风险。
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