Department of Rehabilitation, School of Medical Technology, Tianjin Medical University, Tianjin, People's Republic of China.
Department of Rehabilitation, Tianjin Huanhu Hospital, Tianjin, People's Republic of China.
Clin Interv Aging. 2021 Oct 5;16:1801-1812. doi: 10.2147/CIA.S325930. eCollection 2021.
To determine whether combined performance-based models could exert better predictive values toward discriminating community-dwelling elderly with high risk of any-falls or recurrent-falls.
This prospective cohort study included a total of 875 elderly participants (mean age: 67.10±5.94 years) with 513 females and 362 males, recruited from Hangu suburb area of Tianjin, China. All participants completed comprehensive assessments.
We documented information about sociodemographic information, behavioral characteristics and medical conditions. Three functional tests-timed up and go test (TUGT), walking speed (WS), and grip strength (GS) were used to create combined models. New onsets of any-falls and recurrent-falls were ascertained at one-year follow-up appointment.
In total 200 individuals experienced falls over a one-year period, in which 66 individuals belonged to the recurrent-falls group (33%). According to the receiver operating characteristic curve (ROC), the cutoff points of TUGT, WS, and GS toward recurrent-falls were 10.31 s, 0.9467 m/s and 0.3742 kg/kg respectively. We evaluated good performance as "+" while poor performance as "-". After multivariate adjustment, we found "TUGT >10.31 s" showed a strong correlation with both any-falls (adjusted odds ratio (OR)=2.025; 95% confidence interval (CI)=1.425-2.877) and recurrent-falls (adjusted OR=2.150; 95%CI=1.169-3.954). Among combined functional models, "TUGT >10.31 s, GS <0.3742 kg/kg, WS >0.9467 m/s" showed strongest correlation with both any-falls (adjusted OR=5.499; 95%CI=2.982-10.140) and recurrent-falls (adjusted OR=8.260; 95%CI=3.880-17.585). And this combined functional model significantly increased discriminating abilities on screening recurrent-fallers than a single test (C-statistics=0.815, 95%CI=0.782-0.884, <0.001), while not better than a single test in predicting any-fallers (=0.083).
Elderly people with poor TUGT performance, weaker GS but quicker WS need to be given high priority toward fall prevention strategies for higher risks and frequencies. Meanwhile, the combined "TUGT-, GS-, WS+" model presents increased discriminating ability and could be used as a conventional tool to discriminate recurrent-fallers in clinical practice.
确定基于综合表现的模型是否能更好地预测社区居住的有高跌倒风险或复发性跌倒风险的老年人。
本前瞻性队列研究共纳入了 875 名参与者（平均年龄：67.10±5.94 岁），其中 513 名女性和 362 名男性，均来自中国天津汉沽郊区。所有参与者都完成了全面评估。
我们记录了社会人口统计学信息、行为特征和医疗状况。使用三项功能测试——计时起立行走测试（TUGT）、步行速度（WS）和握力（GS）来创建综合模型。在一年的随访中确定新的任何跌倒和复发性跌倒的发生情况。
在一年的时间里，共有 200 人经历了跌倒，其中 66 人属于复发性跌倒组（33%）。根据受试者工作特征曲线（ROC），TUGT、WS 和 GS 对复发性跌倒的截断点分别为 10.31 秒、0.9467 米/秒和 0.3742 千克/千克。我们将表现良好定义为“+”，表现不佳定义为“-”。经过多变量调整后，我们发现“TUGT>10.31 秒”与任何跌倒（调整后的优势比（OR）=2.025；95%置信区间（CI）=1.425-2.877）和复发性跌倒（调整后的 OR=2.150；95%CI=1.169-3.954）都有很强的相关性。在综合功能模型中，“TUGT>10.31 秒，GS<0.3742 千克/千克，WS>0.9467 米/秒”与任何跌倒（调整后的 OR=5.499；95%CI=2.982-10.140）和复发性跌倒（调整后的 OR=8.260；95%CI=3.880-17.585）都有最强的相关性。并且，与单一测试相比，该综合功能模型在筛查复发性跌倒者方面具有显著更高的区分能力（C 统计量=0.815，95%CI=0.782-0.884，<0.001），但在预测任何跌倒者方面并不优于单一测试（=0.083）。
表现出 TUGT 性能差、握力弱但步行速度快的老年人需要优先采取跌倒预防策略，以降低高风险和高频率跌倒的发生。同时，“TUGT、GS、WS+”联合模型具有更高的区分能力，可以作为临床实践中鉴别复发性跌倒者的常规工具。
