衰弱、跌倒和较差的功能移动性预测老年人因担心跌倒而出现新的活动受限：一项前瞻性 12 个月队列研究。
Frailty, falls and poor functional mobility predict new onset of activity restriction due to concerns about falling in older adults: a prospective 12-month cohort study.
机构信息
Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK.
Centre for Cognitive Neuroscience, Department of Clinical Sciences, Brunel University London, Uxbridge, UK.
出版信息
Eur Geriatr Med. 2023 Apr;14(2):345-351. doi: 10.1007/s41999-023-00749-2. Epub 2023 Feb 5.
PURPOSE
Concerns about falling are common in older adults and often cause activity restriction. This can lead to physical deconditioning, falls and social isolation. However, not every concerned older adult will restrict their activities. This 12-month longitudinal study investigated the physical and psychosocial factors that predict the new onset of activity restriction due to concerns about falling in older people.
METHODS
Participants were 543 older adults (M = 80.3 ± 4.4 years, range: 75-98) who did not report activity restriction due to concerns about falling at Timepoint-1 (negative response to the following question: "Do concerns about falling stop you going out-and-about?"). Participants completed a battery of physical and psychological assessments at Timepoint-1. Using binary logistic regression, we then assessed which of these variables predicted whether participants reported having started restricting their activity due to concerns about falling at the 12-month follow-up (Timepoint 2).
RESULTS
10.1% of the sample started to restrict activity due to concerns about falling at Timepoint 2. Three key predictors significantly predicted activity restriction group status at 12-month follow-up: greater frailty at Timepoint-1 (Fried Frailty Index; OR = 1.58, 95% CI 1.09-2.30), experiencing a fall between Timepoint-1 and 2 (OR = 2.22, 95% CI 1.13-4.38) and poorer functional mobility at Timepoint-1 (Timed up and Go; OR = 1.08, 95% CI 1.01-1.15).
CONCLUSIONS
Frailty, experiencing a fall and poorer functional mobility all predicted the onset of activity restriction due to concerns about falling. Clinicians working in balance and falls-prevention services should regularly screen for frailty, and patients referred to frailty services should likewise receive tailored treatment to help prevent the development of activity restriction due to concerns about falling.
目的
老年人普遍存在对跌倒的担忧，这些担忧常常导致活动受限。这可能导致身体机能下降、跌倒和社交孤立。然而，并非每个有担忧的老年人都会限制他们的活动。本为期 12 个月的纵向研究调查了哪些身体和心理社会因素会预测老年人因担心跌倒而开始出现新的活动受限。
方法
参与者为 543 名老年人（M=80.3±4.4 岁，年龄范围：75-98 岁），他们在时间点 1 时并未因担心跌倒而报告活动受限（对以下问题的否定回答：“担心跌倒是否阻止你外出活动？”）。参与者在时间点 1 时完成了一系列身体和心理评估。然后，我们使用二项逻辑回归评估了这些变量中哪些变量可以预测在 12 个月的随访（时间点 2）时，参与者是否报告开始因担心跌倒而限制自己的活动。
结果
该样本中有 10.1%的人在时间点 2 时开始因担心跌倒而限制活动。三个关键预测因素显著预测了 12 个月随访时的活动受限组状态：时间点 1 时的衰弱程度更高（Fried 衰弱指数；OR=1.58，95%CI 1.09-2.30）、在时间点 1 和 2 之间发生跌倒（OR=2.22，95%CI 1.13-4.38）以及时间点 1 时的功能性移动能力更差（计时起立行走；OR=1.08，95%CI 1.01-1.15）。
结论
衰弱、跌倒和较差的功能性移动能力都预测了因担心跌倒而开始限制活动。在平衡和跌倒预防服务中工作的临床医生应定期筛查衰弱，向衰弱服务转诊的患者也应接受量身定制的治疗，以帮助预防因担心跌倒而导致的活动受限。
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