Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
The Menniger Clinic, Houston, Texas, USA.
Gerontology. 2021;67(3):365-373. doi: 10.1159/000512977. Epub 2021 Feb 3.
Concern about falling is a prevalent worry among community-dwelling older adults and may contribute to a decline in physical and mental health. This study aimed to examine the association between mobility performance and concern about falling.
Older adults aged 65 years and older, with Mini-Mental State Examination score ≥24, and ambulatory (with or without the assistive device) were included. Concern about falling was evaluated with Falls Efficacy Scale-International (FES-I) scores. Participants with high concern about falling were identified using the cutoff of FES-I ≥23. Participants' motor capacity was assessed in standardized walking tests under single- and dual-task conditions. Participants' mobility performance was measured based on a 48-h trunk accelerometry signal from a wearable pendant sensor.
No significant differences were observed at participant characteristics across groups with different levels of concern about falling (low: N = 64, age = 76.3 ± 7.2 years, female = 46%; high: N = 59, age = 79.3 ± 9.1 years, female = 47%), after propensity matching with BMI, age, depression, and cognition. With adjustment of motor capacity (stride velocity and stride length under single- and dual-task walking conditions), participants with high concern about falling had significantly poorer mobility performance than those with low concern about falling, including lower walking quantity (walking bouts, steps and time per day, and walking bout average, walking bout variability, and longest walking bout, p ≤ 0.013), and poorer daily-life gait (stride velocity and gait variability, p ≤ 0.023), and poorer walking quality (frontal gait symmetry, and trunk acceleration and velocity intensity, p ≤ 0.041). The selected mobility performance metrics (daily steps and frontal gait symmetry) could significantly contribute to identifying older adults with high concern about falling (p ≤ 0.042), having better model performance (p = 0.036) than only walking quantity (daily steps) with adjustment of confounding effects from the motor capacity (stride length under dual-task walking condition).
There is an association between mobility performance and concern about falling in older adults. Mobility performance metrics can serve as predictors to identify older adults with high concern about falling, potentially providing digital biomarkers for clinicians to remotely track older adults' change of concern about falling via applications of remote patient monitoring.
担心跌倒普遍困扰着社区居住的老年人，并可能导致身心健康状况恶化。本研究旨在探讨移动能力与担心跌倒之间的关系。
纳入年龄在 65 岁及以上、简易精神状态检查评分≥24 分且能自主行走（无论是否使用辅助设备）的老年人。使用跌倒效能量表国际版（FES-I）评估对跌倒的担忧程度。使用 FES-I≥23 的截点值确定对跌倒高度担忧的参与者。在单任务和双任务条件下，使用标准化步行测试评估参与者的运动能力。使用可穿戴吊坠传感器在 48 小时躯干加速度计信号的基础上测量参与者的移动能力。
在不同担忧程度（低：N=64，年龄=76.3±7.2 岁，女性占 46%；高：N=59，年龄=79.3±9.1 岁，女性占 47%）的参与者中，根据身体质量指数、年龄、抑郁和认知进行倾向评分匹配后，各组参与者的特征无显著差异。调整运动能力（单任务和双任务步行时步速和步长）后，与低担忧程度的参与者相比，高担忧程度的参与者移动能力明显更差，包括较低的行走量（每日行走次数、步数和时间，以及行走次数平均值、行走次数变异性和最长行走次数，p≤0.013），较差的日常生活步态（步速和步态变异性，p≤0.023），以及较差的行走质量（额状面步态对称性和躯干加速度及速度强度，p≤0.041）。所选移动能力指标（每日步数和额状面步态对称性）可以显著有助于识别对跌倒高度担忧的老年人（p≤0.042），与仅调整运动能力混淆因素（双任务行走时步长）后的每日步数相比，具有更好的模型性能（p=0.036）。
在老年人中，移动能力与对跌倒的担忧之间存在关联。移动能力指标可以作为识别对跌倒高度担忧的老年人的预测指标，为临床医生通过远程患者监测应用程序远程跟踪老年人对跌倒担忧的变化提供数字生物标志物。
