New England Geriatric Research and Education Clinical Center (GRECC), VA Boston Healthcare System, Massachusetts.
Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, Massachusetts.
J Gerontol A Biol Sci Med Sci. 2019 Aug 16;74(9):1526-1532. doi: 10.1093/gerona/glz030.
Neuromuscular and clinical factors contribute to falls among older adults, yet the interrelated nature of these factors is not well understood. We investigated the relationships between these factors and how they contribute to falls, which may help optimize fall risk assessment and prevention.
A total of 365 primary care patients (age = 77 ± 7, 67% female) were included from the Boston Rehabilitative Impairment Study of the Elderly. Neuromuscular measures included leg strength and leg velocity, trunk extensor endurance, and knee range of motion. Clinical measures included memory, executive function, depressive symptoms, pain, sensory loss, vision, comorbidity, physical activity, mobility self-efficacy, and psychiatric medication. Factor analysis was used to evaluate clustering of factors. Negative binomial regression assessed the relationship of factors with three-year fall rate. Interactions were tested to examine whether clinical factors modified the relationship between neuromuscular factors and falls.
Three factors emerged: (i) neuromuscular factors, pain, and self-efficacy; (ii) memory; and (iii) executive function. Having three neuromuscular impairments predicted higher fall rate (incidence rate ratio [95% confidence interval]: 3.39 [1.82-6.32]) but was attenuated by memory (1.69 [1.10-2.61]), mobility self-efficacy (0.99 [0.98-0.99]), psychiatric medication use (1.54 [1.10-2.14]), and pain (1.13 [1.04-1.23]). Pain modified the relationship between neuromuscular impairment burden (number of neuromuscular impairments) and falls. Having three neuromuscular impairments was associated with a higher fall rate in patients with high levels of pain (5.73 [2.46-13.34]) but not among those with low pain.
Neuromuscular impairment burden was strongly associated with fall rate in older adults with pain. These factors should be considered together during fall risk assessment, post fall assessment, and prevention.
神经肌肉和临床因素都会导致老年人跌倒，但这些因素之间的相互关系尚不清楚。我们研究了这些因素之间的关系以及它们如何导致跌倒，这可能有助于优化跌倒风险评估和预防。
共有 365 名来自波士顿老年康复障碍研究的初级保健患者（年龄=77±7，67%为女性）被纳入本研究。神经肌肉测量包括腿部力量和腿部速度、躯干伸肌耐力和膝关节活动范围。临床测量包括记忆力、执行功能、抑郁症状、疼痛、感觉丧失、视力、合并症、身体活动、移动自我效能和精神药物。使用因子分析评估因素的聚类情况。使用负二项回归评估因素与三年跌倒率的关系。测试了交互作用，以检验临床因素是否改变了神经肌肉因素与跌倒之间的关系。
出现了三个因素：（i）神经肌肉因素、疼痛和自我效能；（ii）记忆力；和（iii）执行功能。有三个神经肌肉损伤预测更高的跌倒率（发病率比[95%置信区间]：3.39[1.82-6.32]），但记忆（1.69[1.10-2.61]）、移动自我效能（0.99[0.98-0.99]）、精神药物使用（1.54[1.10-2.14]）和疼痛（1.13[1.04-1.23]）会减弱这种关系。疼痛改变了神经肌肉损伤负担（神经肌肉损伤数量）与跌倒之间的关系。在疼痛程度较高的患者中，有三个神经肌肉损伤与更高的跌倒率相关（5.73[2.46-13.34]），但在疼痛程度较低的患者中则没有。
神经肌肉损伤负担与有疼痛的老年人的跌倒率密切相关。在跌倒风险评估、跌倒后评估和预防中，应综合考虑这些因素。
