Division of Geriatrics and Gerontology, Department of Medicine, Emory University, Atlanta, Georgia.
Emory University College of Arts and Sciences, Atlanta, Georgia.
J Geriatr Phys Ther. 2023;46(2):122-131. doi: 10.1519/JPT.0000000000000364. Epub 2022 Aug 18.
Falling among older adults is common and can cause chronic health complications. Fear of falling, a lasting concern about falling that can lead an individual to avoid activities he or she can perform, is strongly associated with falling and fall risk. Although White older adults fall more often, Black older adults have more fall risk factors. The purpose of this study was to investigate factors that explain fear of falling and differences between White and Black community-dwelling older adults in fear of falling, balance confidence, and fall risk factors.
Using a cross-sectional, retrospective design, 84 community-dwelling older adults (mean age [SD] = 69.0 [5.2], range: 55-80; White, n = 37, 44%; Black, n = 47, 56%, M/F = 20/64) were assessed. Assessments were conducted in a laboratory for human studies. Fall history and risk factors, and subjective fear of falling, were collected. The Montreal Cognitive Assessment (MoCA), Activities-Specific Balance Confidence (ABC) score, preferred, backward, and fast Gait Speed, Short Form-12 Physical and Mental Component Scores, fear of falling rating scale, and demographics questionnaires were administered. Analyses included a proportional odds logistic regression model to examine which factors predicted ABC score and which factors were associated with subjective fear of falling, 1-way analysis of variance for continuous variables, the Fisher exact test for categorical variables, and the Mann-Whitney-Wilcoxon test for ordinal variables.
Black participants had significantly fewer years of education ( P = .007), lower MoCA scores ( P = .002), and slower fast gait speed ( P = .032) than White participants. Black participants reported less subjective fear of falling ( P = .043). In the final ABC model (Akaike information criterion 208.26), lower ABC scores were predicted by White race, slower preferred and fast gait speeds, and worse Short Form-12 Mental Composite Scores.
Despite Black participants demonstrating typical characteristics of higher fall risk including lower cognitive scores, slower gait speed, and lower ABC scores, Black participants reported fewer falls. Understanding racial differences is an important factor in fear of falling and balance confidence.
Reasons for racial differences should be examined further in fear of falling and balance confidence to facilitate the development of patient-centered falls prevention physical therapy programs.
老年人跌倒较为常见，可能导致慢性健康并发症。对跌倒的恐惧是对跌倒的持久担忧，可能导致个体避免其能够进行的活动，与跌倒和跌倒风险密切相关。尽管白人老年人跌倒更为频繁，但黑人老年人的跌倒风险因素更多。本研究旨在调查解释跌倒恐惧的因素，以及白人和黑人社区居住的老年人在跌倒恐惧、平衡信心和跌倒风险因素方面的差异。
采用横断面、回顾性设计，评估 84 名社区居住的老年人（平均年龄[标准差]为 69.0[5.2]岁，范围：55-80 岁；白人，n=37，44%；黑人，n=47，56%，M/F=20/64）。在人类研究实验室进行评估。收集跌倒史和风险因素，以及主观跌倒恐惧。进行蒙特利尔认知评估（MoCA）、特定活动平衡信心（ABC）评分、首选、后退和快速步态速度、简短形式-12 身体和精神成分评分、跌倒恐惧评分量表和人口统计学问卷。分析包括比例优势逻辑回归模型，以检查哪些因素预测 ABC 评分，哪些因素与主观跌倒恐惧相关，连续变量的单因素方差分析，分类变量的 Fisher 精确检验，以及有序变量的 Mann-Whitney-Wilcoxon 检验。
与白人参与者相比，黑人参与者受教育年限明显较少（P=0.007），MoCA 评分较低（P=0.002），快速步态速度较慢（P=0.032）。黑人参与者报告的主观跌倒恐惧较少（P=0.043）。在最终的 ABC 模型（Akaike 信息准则 208.26）中，白人种族、较慢的首选和快速步态速度以及较差的简短形式-12 精神成分评分预测 ABC 评分较低。
尽管黑人参与者表现出更高跌倒风险的典型特征，包括较低的认知评分、较慢的步态速度和较低的 ABC 评分，但黑人参与者报告的跌倒次数较少。了解种族差异是跌倒恐惧和平衡信心的一个重要因素。
应进一步探讨种族差异的原因，以促进以患者为中心的跌倒预防物理治疗计划的发展。
