Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland.
Centre on Aging and Mobility, University of Zurich and City Hospital Zurich, Waid, Zurich, Switzerland; Department of Aging Medicine and Aging Research, University of Zurich and University Hospital, Zurich, Switzerland; University Clinic for Aging Medicine, City Hospital Zurich, Waid, Zurich, Switzerland.
J Am Med Dir Assoc. 2023 Jun;24(6):804-810.e4. doi: 10.1016/j.jamda.2022.12.011. Epub 2023 Jan 17.
To examine the association between the baseline number of chronic diseases and multimorbidity with regard to the incidence of all and injurious falls over 3 years among European community-dwelling older adults.
Observational analysis of DO-HEALTH, a double-blind, randomized controlled trial.
Multicenter trial with 7 European centers: Zurich, Basel, Geneva (Switzerland), Berlin (Germany), Innsbruck (Austria), Toulouse (France), and Coimbra (Portugal), including 2157 community-dwelling adults aged 70 years and older without any major health events in the 5 years prior to enrollment, sufficient mobility, and good cognitive status.
The main outcomes were the number of all falls and injurious falls experienced over 3 years. The number of chronic diseases and multimorbidity, defined as the presence of 3 or more chronic diseases at baseline, were assessed with the Self-Administered Comorbidity Questionnaire by Sangha et al.
Among the 2155 participants included in the analyses (mean age: 74.9 years, 62% were women, 52% were physically active more than 3 times a week), 569 (26.4%) had multimorbidity at baseline. Overall, each 1-unit increase in the baseline number of chronic diseases was linearly associated with a 7% increased incidence rate of all falls [adjusted incidence rate ratio (aIRR) 1.07, 95% CI 1.03-1.12, P < .001] and a 6% increased incidence rate of injurious falls (aIRR 1.06, 95% CI 1.02-1.11, P = .003). Baseline multimorbidity was associated with a 21% increased incidence rate of all falls (aIRR 1.21, 95% CI 1.07-1.37, P = .002) and a 17% increased incidence rate of injurious falls (aIRR 1.17, 95% CI 1.03-1.32, P = .02).
Baseline number of prevalent chronic diseases and multimorbidity in generally healthy and active community-dwelling older adults were associated with increased incidence rates of all and injurious falls over 3 years. These findings support that multimorbidity may need consideration as a risk factor for falls, even in generally healthy and active older adults.
探讨基线慢性病数量和多种疾病与欧洲社区居住的老年人三年内全因和伤害性跌倒发生率的关系。
DO-HEALTH 的观察性分析，这是一项双盲、随机对照试验。
来自 7 个欧洲中心的多中心试验：苏黎世、巴塞尔、日内瓦（瑞士）、柏林（德国）、因斯布鲁克（奥地利）、图卢兹（法国）和科英布拉（葡萄牙），包括 2157 名年龄在 70 岁及以上、在入组前 5 年内没有任何重大健康事件、具有足够活动能力和良好认知状态的社区居住成年人。
主要结局是三年内发生的所有跌倒和伤害性跌倒的数量。慢性病和多种疾病的数量，定义为基线时存在 3 种或更多种慢性病，通过 Sangha 等人的自我管理合并症问卷进行评估。
在纳入分析的 2155 名参与者中（平均年龄：74.9 岁，62%为女性，52%每周进行 3 次以上的体育活动），569 名（26.4%）基线时患有多种疾病。总体而言，基线慢性病数量每增加 1 个单位，全因跌倒的发生率就会线性增加 7%[调整发病率比（aIRR）1.07，95%CI 1.03-1.12，P<0.001]，伤害性跌倒的发生率增加 6%（aIRR 1.06，95%CI 1.02-1.11，P=0.003）。基线时患有多种疾病与全因跌倒的发生率增加 21%相关（aIRR 1.21，95%CI 1.07-1.37，P=0.002），伤害性跌倒的发生率增加 17%相关（aIRR 1.17，95%CI 1.03-1.32，P=0.02）。
一般健康和活跃的社区居住老年人基线时常见慢性疾病和多种疾病的数量与三年内全因和伤害性跌倒发生率的增加有关。这些发现支持即使在一般健康和活跃的老年人中，多种疾病也可能需要被视为跌倒的风险因素。
