Department of Biomedical Engineering, Faculty of Engineering, University of Malaya, 50603, Kuala Lumpur, Malaysia.
Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
Biomed Eng Online. 2022 May 5;21(1):29. doi: 10.1186/s12938-022-00996-7.
Falls among older adults have become a global concern. While previous studies have established associations between autonomic function indicator; heart rate variability (HRV) and blood pressure variability (BPV) with fall recurrence, as well as physical inactivity and psychological disorders as risk factors for falls, the influence of physical activity and psychological status on autonomic dysfunction observed among older fallers has not been adequately investigated. The aim of this study was to evaluate the relationship between psychological disorder and physical performance on the autonomic nervous system (ANS) in older fallers. We hypothesised that older fallers have poorer autonomic function, greater dependency on others and were associated with psychological disorders. Furthermore, we hypothesised that both physical performance and psychological status can contribute to the worsening of the autonomic function among the elderly.
In this cross-sectional survey, adults aged ≥ 60 years were recruited. Continuous non-invasive BP was monitored over 5 min of supine and 3 min of standing. Psychological status was assessed in terms of depression, anxiety, stress, and concern about falling, while functional status was measured using time-up-and-go, functional reach, handgrip and Lawton's Instrumental Activities of Daily Life (IADL) scale.
A total of 62 participants were recruited consisting of 37 fallers and 25 non-fallers. Multivariate analysis revealed that Lawton IADL was independently associated with systolic blood pressure variability (SBPV) and diastolic blood pressure variability (DBPV) during both supine (SBPV: r = 0.080, p = 0.025; DBPV: r = 0.064, p = 0.046) and standing (SBPV: r = 0.112, p = 0.008; DBPV: r = 0.105, p = 0.011), while anxiety score was independently associated with SBPV and DBPV during standing (SBPV: r = 0.112, p = 0.009; DBPV: r = 0.105, p = 0.011) as compared to the other parameters.
Our findings suggest that fallers had poorer ANS, greater dependence in IADLs, and were more anxious. IADL dependency and anxiety were the most predictive of autonomic dysfunction, and can be used in practice to identify poor autonomic function for the prevention of falls and cardiovascular diseases among older adults.
老年人跌倒已成为全球关注的问题。虽然先前的研究已经确定了自主功能指标；心率变异性（HRV）和血压变异性（BPV）与跌倒复发的关系，以及身体活动不足和心理障碍是跌倒的危险因素，但尚未充分研究身体活动和心理状态对老年跌倒者自主神经功能障碍的影响。本研究旨在评估心理障碍与老年跌倒者自主神经系统（ANS）的身体表现之间的关系。我们假设老年跌倒者的自主功能较差，对他人的依赖性更大，并且与心理障碍有关。此外，我们假设身体表现和心理状况都可能导致老年人自主功能恶化。
在这项横断面研究中，招募了年龄≥60 岁的成年人。连续监测仰卧 5 分钟和站立 3 分钟的非侵入性血压。使用时间上下、功能伸手、握力和 Lawton 的日常生活活动工具（IADL）量表评估心理状态，包括抑郁、焦虑、压力和对跌倒的担忧。
共招募了 62 名参与者，其中 37 名跌倒者和 25 名非跌倒者。多变量分析显示，Lawton IADL 与仰卧位时的收缩压变异性（SBPV）和舒张压变异性（DBPV）（SBPV：r=0.080，p=0.025；DBPV：r=0.064，p=0.046）和站立时（SBPV：r=0.112，p=0.008；DBPV：r=0.105，p=0.011）独立相关，而焦虑评分与站立时的 SBPV 和 DBPV 独立相关（SBPV：r=0.112，p=0.009；DBPV：r=0.105，p=0.011）。
我们的研究结果表明，跌倒者的自主神经系统功能较差，对 IADL 的依赖性更大，而且更焦虑。IADL 依赖性和焦虑是自主神经功能障碍的最具预测性因素，可用于实践中识别自主功能不良，以预防老年人跌倒和心血管疾病。
