Xiangya School of Nursing, Central South University, Changsha, China.
Graduate College of Social Work, University of Houston, Houston, TX, USA.
BMC Geriatr. 2022 Dec 1;22(1):923. doi: 10.1186/s12877-022-03588-1.
Previous research has shown an association between homebound status and falls among older adults. However, this association was primarily drawn from cross-sectional studies. This study aimed to determine the bidirectional relationship between homebound status and falls among older adults in the community.
We used data of the community-dwelling older adults from 2011 to 2015 of the National Health and Aging Trends Study, a nationally representative survey of Medicare Beneficiaries in the United States (Sample 1 [No falls at baseline]: N = 2,512; Sample 2 [Non-homebound at baseline]: N = 2,916). Homebound status was determined by the frequency, difficulty, and needing help for outdoor mobility. Falls were ascertained by asking participants whether they had a fall in the last year. Generalized estimation equation models were used to examine the bidirectional association between homebound status and falls longitudinally.
Participants with no falls at baseline (n = 2,512) were on average, 76.8 years old, non-Hispanic whites (70.1%), and female (57.1%). After adjusting for demographics and health-related variables, prior year homebound status significantly contributed to falls in the following year (Odds ratio [OR], 1.28, 95% CI: 1.09-1.51). Participants who were non-homebound at baseline (n = 2,916) were on average, 75.7 years old, non-Hispanic white (74.8%), and female (55.8%). Previous falls significantly predicted later homebound status (OR, 1.26, 95% CI: 1.10-1.45) in the full adjusted model.
This is the first longitudinal study to determine the bidirectional association between homebound status and falls. Homebound status and falls form a vicious circle and mutually reinforce each other over time. Our findings suggest the importance of developing programs and community activities that reduce falls and improve homebound status among older adults.
先前的研究表明，居家状态与老年人跌倒之间存在关联。然而，这种关联主要来自于横断面研究。本研究旨在确定社区中老年人居家状态和跌倒之间的双向关系。
我们使用了来自美国医疗保险受益人的全国健康和老龄化趋势研究的 2011 年至 2015 年社区居住的老年人数据（基线时无跌倒的样本 1 [N=2512]；基线时非居家的样本 2 [N=2916]）。居家状态通过户外移动的频率、难度和需要帮助来确定。通过询问参与者在过去一年中是否跌倒来确定跌倒情况。使用广义估计方程模型来纵向检查居家状态和跌倒之间的双向关联。
基线时无跌倒的参与者（n=2512）平均年龄为 76.8 岁，非西班牙裔白人（70.1%），女性（57.1%）。调整人口统计学和健康相关变量后，前一年的居家状态显著增加了下一年跌倒的风险（优势比 [OR]，1.28，95%可信区间：1.09-1.51）。基线时非居家的参与者（n=2916）平均年龄为 75.7 岁，非西班牙裔白人（74.8%），女性（55.8%）。在完全调整的模型中，先前的跌倒显著预测了后来的居家状态（OR，1.26，95%可信区间：1.10-1.45）。
这是第一项确定居家状态和跌倒之间双向关系的纵向研究。居家状态和跌倒形成了一个恶性循环，随着时间的推移相互加强。我们的研究结果表明，开发旨在减少老年人跌倒和改善居家状态的计划和社区活动的重要性。
