老年人无家可归者跌倒的风险因素：来自 HOPE HOME 队列研究的结果。
Risk Factors for Falls in Older Adults Experiencing Homelessness: Results from the HOPE HOME Cohort Study.
机构信息
School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.
出版信息
J Gen Intern Med. 2020 Jun;35(6):1813-1820. doi: 10.1007/s11606-020-05637-0. Epub 2020 Jan 21.
BACKGROUND
More than half of homeless adults are of age ≥ 50 years. Falls are a common cause of morbidity in older adults in the general population. Risk factors for falls in the general population include poor health, alcohol use, and exposure to unsafe environments. Homeless adults aged ≥ 50 have a high prevalence of known risk factors and face additional potential risks.
OBJECTIVES
To examine the prevalence of and risk of falling in a cohort of older homeless adults.
DESIGN
Longitudinal cohort study with participant interviews every 6 months for 3 years; data were analyzed using generalized estimating equations (GEEs).
PARTICIPANTS
Three hundred fifty adults aged ≥ 50, homeless at study entry, recruited via population-based sampling.
MEASURES
The dependent variable is any falls in prior 6 months; independent variables include individual (i.e., illness, behaviors) and social/environmental (i.e., social support, experiencing violence, living unsheltered) factors.
RESULTS
Over three quarters of participants were men (77.1%) and Black (79.7%). The median age was 58 (IQR 54, 61). At baseline, one third (33.7%) reported a fall in the prior 6 months. At follow-up visits, 23.1% to 31.2% of participants reported having fallen. In GEE models, individual risk factors (non-Black race, being a women, older age, functional impairment, urinary incontinence, history of stroke, and use of assistive devices, opioid, and marijuana) were associated with increased odds of falls. Environmental and social factors (spending any nights unsheltered (adjusted odds ratio (AOR) = 1.42, CI = 1.10-1.83) and experiencing physical assault (AOR = 1.67, CI = 1.18-2.37) were also associated.
CONCLUSIONS
Older homeless adults fall frequently. Likely contributors include having a high prevalence of conditions that increase the risk of falls, compounded by heightened exposure to unsafe environments. Fall prevention in this population should target those at highest risk and address modifiable environmental conditions. Providing shelter or housing and addressing substance use could reduce morbidity from falls in homeless older adults.
背景
超过一半的无家可归成年人年龄在 50 岁以上。跌倒在普通人群中的老年人中是导致发病的常见原因。普通人群中跌倒的危险因素包括健康状况不佳、饮酒和接触不安全环境。年龄在 50 岁及以上的无家可归成年人有较高的已知危险因素患病率，并面临额外的潜在风险。
目的
检查一个年龄较大的无家可归成年人队列中的跌倒发生率和跌倒风险。
设计
纵向队列研究，参与者每 6 个月接受一次访谈，为期 3 年；使用广义估计方程（GEE）分析数据。
参与者
通过基于人群的抽样方法招募了 350 名年龄在 50 岁及以上、在研究开始时无家可归的成年人。
测量
因变量为过去 6 个月内任何跌倒的情况；自变量包括个人（即疾病、行为）和社会/环境（即社会支持、遭受暴力、无家可归）因素。
结果
超过四分之三的参与者为男性（77.1%）和黑人（79.7%）。中位年龄为 58（IQR 54，61）。在基线时，三分之一（33.7%）报告在过去 6 个月内跌倒过。在随访期间，23.1%至 31.2%的参与者报告有过跌倒。在 GEE 模型中，个人危险因素（非黑人种族、女性、年龄较大、功能障碍、尿失禁、中风史以及使用辅助设备、阿片类药物和大麻）与跌倒的可能性增加相关。环境和社会因素（任何夜晚无家可归（调整后的优势比（AOR）= 1.42，CI= 1.10-1.83）和经历身体攻击（AOR= 1.67，CI= 1.18-2.37）也与跌倒有关。
结论
年龄较大的无家可归成年人经常跌倒。可能的原因包括存在增加跌倒风险的高发疾病，再加上接触不安全环境的风险增加。该人群的跌倒预防应针对风险最高的人群，并解决可改变的环境条件。提供住所或住房并解决药物滥用问题可能会降低无家可归的老年人群中因跌倒导致的发病率。
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