E Jian-Yu, Mihailovic Aleksandra, Schrack Jennifer A, Li Tianjing, Friedman David S, West Sheila K, Gitlin Laura N, Ramulu Pradeep Y
Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2021 May;69(5):1249-1256. doi: 10.1111/jgs.17014. Epub 2021 Jan 8.
Older adults with visual impairments experience a higher risk of falling, and are more vulnerable to adverse health consequences associated with falls than those with normal vision. This study characterizes longitudinal changes in objectively measured physical activity and fear of falling (FoF) occurring after various types of falls in visually impaired older adults.
Prospective cohort study.
Hospital-based enrollment.
People with glaucoma or suspected glaucoma.
Falls were defined as unintentionally coming to rest on the ground or a lower level, and injurious falls were determined though follow-up calls. Study participants were categorized into three groups-fallers with injurious consequences, fallers without injurious consequences, and non-fallers based on fall status in the first year. Physical activity was assessed by waist-bound accelerometer. FoF was evaluated by questionnaire, with Rasch modeling generating FoF scores where higher scores reflected worse FoF. The 3-year longitudinal changes of physical activity and FoF were modeled using mixed-effects models.
In linear models fully adjusted for visual field damage and other covariates, physical activity among injurious fallers showed greater annual (per year) declines in daily steps (-425 steps/d, 95% confidence interval (CI) = -793, -57), daily active minutes (-13 min/d, 95% CI = -21, -6), and daily moderate and vigorous physical activity (MVPA) minutes (-3 MVPA minutes/d, 95% CI = -5, 0) over the 3-year period as compared to non-fallers; however, physical activity did not significantly decline among non-injurious fallers. No longitudinal increases in FoF scores were observed in injurious or non-injurious fallers when compared to non-fallers.
Among visually impaired older adults, injurious falls identified prospectively over 12 months contributed to a significant decline in physical activity over a 3-year period, while minimal changes were observed in FoF.
视力受损的老年人跌倒风险更高，与视力正常的老年人相比，他们更容易受到跌倒相关不良健康后果的影响。本研究描述了视力受损老年人在经历各种类型的跌倒后，客观测量的身体活动和跌倒恐惧（FoF）的纵向变化。
前瞻性队列研究。
基于医院的入组。
患有青光眼或疑似青光眼的人。
跌倒定义为无意中倒在地上或较低的平面上，通过随访电话确定有伤害性的跌倒。根据第一年的跌倒状况，研究参与者被分为三组：有伤害性后果的跌倒者、无伤害性后果的跌倒者和未跌倒者。通过佩戴在腰部的加速度计评估身体活动。通过问卷调查评估跌倒恐惧，采用拉施模型生成跌倒恐惧得分，得分越高表明跌倒恐惧越严重。使用混合效应模型对身体活动和跌倒恐惧的3年纵向变化进行建模。
在对视野损害和其他协变量进行充分调整的线性模型中，与未跌倒者相比，有伤害性跌倒者在3年期间的每日步数（-425步/天，95%置信区间（CI）=-793，-57）、每日活动分钟数（-13分钟/天，95%CI=-21，-6）以及每日中等强度和剧烈身体活动（MVPA）分钟数（-3 MVPA分钟/天，95%CI=-5，0）每年下降幅度更大；然而，无伤害性跌倒者的身体活动没有显著下降。与未跌倒者相比，有伤害性或无伤害性跌倒者的跌倒恐惧得分没有纵向增加。
在视力受损的老年人中，前瞻性确定的12个月内发生的有伤害性跌倒导致3年内身体活动显著下降，而跌倒恐惧变化极小。
