Scholz Katharina, Geritz Johanna, Kudelka Jennifer, Rogalski Marten, Niemann Katharina, Maetzler Corina, Welzel Julius, Drey Michael, Prell Tino, Maetzler Walter
Department of Neurology, University Hospital Schleswig-Holstein, Kiel, Germany.
Department of Medicine IV, Geriatrics, University Hospital of LMU Munich, Munich, Germany.
Front Med (Lausanne). 2022 Jun 21;9:904364. doi: 10.3389/fmed.2022.904364. eCollection 2022.
Fear of falling (FOF) negatively affects health-related quality of life and is common in neurogeriatric patients, however, related parameters are not well understood. This study investigated the relationship between FOF, physical performance (as assessed with the Short Physical Performance Battery and its subscores) and other aspects of sarcopenia in a sample of hospitalized neurogeriatric patients.
In 124 neurogeriatric patients, FOF was assessed with the Falls Efficacy Scale International (FES-I). Physical performance was measured using the Short Physical Performance Battery (SPPB) including walking duration, balance and five times sit-to-stand task (5xSST) subscores. Appendicular skeletal muscle mass (ASMM) was estimated with the cross-validated Sergi equation using Bioelectrical impedance analysis measures. The Depression im Alter-Skala (DIA-S) was used to assess depressive symptoms. Multiple regression models with FES-I score as outcome variable were computed using backward selection with AICc as selection criterion, including: (i) SPPB total score, ASMM/height, grip strength, age, gender, positive fall history, number of medications, use of a walking aid, DIA-S score and Montreal Cognitive Assessment (MoCA) score; and (ii) SPPB subscores, ASMM/height, grip strength, age, gender, positive fall history, number of medications, DIA-S score and MoCA score, once with and once without including use of a walking aid as independent variable.
Lower SPPB total score, as well as lower SPPB balance and 5xSST subscores were associated with higher FES-I scores, but SPPB walking duration subscore was not. Moreover, DIA-S, number of medications and use of a walking aid were significantly associated with FOF.
Our preliminary results suggest that -if confirmed by subsequent studies- it may be worthwhile to screen patients with low SPPB balance and 5xSST subscores for FOF, and to treat especially these mobility deficits in neurogeriatric patients with FOF. Moreover, training neurogeriatric patients to use their walking aids correctly, critical evaluation of medication and treating depressive symptoms may further help reduce FOF in this highly vulnerable cohort.
害怕跌倒（FOF）会对健康相关生活质量产生负面影响，在老年神经科患者中很常见，然而，相关参数尚未得到充分了解。本研究在一组住院老年神经科患者样本中，调查了FOF、身体机能（通过简短身体机能测试及其子分数评估）与肌肉减少症其他方面之间的关系。
对124名老年神经科患者，使用国际跌倒效能量表（FES-I）评估FOF。使用简短身体机能测试（SPPB）测量身体机能，包括步行时间、平衡能力和五次坐立试验（5xSST）子分数。使用生物电阻抗分析测量值，通过交叉验证的塞尔吉方程估计四肢骨骼肌质量（ASMM）。使用老年抑郁量表（DIA-S）评估抑郁症状。以FES-I分数作为结果变量，采用以AICc为选择标准的向后选择法计算多元回归模型，包括：（i）SPPB总分、ASMM/身高、握力、年龄、性别、跌倒史阳性、用药数量、使用助行器情况、DIA-S分数和蒙特利尔认知评估（MoCA）分数；（ii）SPPB子分数、ASMM/身高、握力、年龄、性别、跌倒史阳性、用药数量、DIA-S分数和MoCA分数，自变量一次包含、一次不包含使用助行器情况。
较低的SPPB总分，以及较低的SPPB平衡能力和5xSST子分数与较高的FES-I分数相关，但SPPB步行时间子分数与FES-I分数无关。此外，DIA-S、用药数量和使用助行器情况与FOF显著相关。
我们的初步结果表明——如果后续研究得到证实——对于SPPB平衡能力和5xSST子分数较低的患者筛查FOF可能是值得的，并且尤其要治疗老年神经科FOF患者的这些运动功能缺陷。此外，训练老年神经科患者正确使用助行器、严格评估用药情况以及治疗抑郁症状可能会进一步帮助降低这个高度脆弱群体的FOF。
