Division of Vascular Surgery and Endovascular Therapy, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
J Am Geriatr Soc. 2023 Jun;71(6):1902-1909. doi: 10.1111/jgs.18338. Epub 2023 Mar 21.
In persons with diabetes, annual screening for peripheral neuropathy (PN) using monofilament testing is the standard of care. However, PN detected by monofilament testing is common in older adults, even in the absence of diabetes. We aimed to assess the association of PN with risk of falls and fractures in older adults.
We included participants in the Atherosclerosis Risk in Communities (ARIC) Study who underwent monofilament testing at visit 6 (2016-2017). Incident falls and fractures were identified based on ICD-9 and ICD-10 codes from active surveillance of all hospitalizations and linkage to Medicare claims. We used Cox models to assess the association of PN with falls and fractures (combined and as separate outcomes) after adjusting for demographics and risk factors for falls.
There were 3617 ARIC participants (mean age 79.4 [SD 4.7] years, 40.8% male, and 21.4% Black adults), of whom 1242 (34.3%) had PN based on monofilament testing. During a median follow-up of 2.5 years, 371 participants had a documented fall, and 475 participants had a documented fracture. The incidence rate (per 1000 person-years) for falls or fractures for participants with PN versus those without PN was 111.1 versus 74.3 (p < 0.001). The age-, sex-, and race-adjusted 3-year cumulative incidence of incident fall or fracture was significantly higher for participants with PN versus those without PN (26.5% vs. 18.4%, p < 0.001). After adjusting for demographics, PN remained independently associated with falls and fractures (HR 1.48, 95% CI 1.26, 1.74). Results were similar for models including traditional risk factors for falls, when falls and fractures were analyzed as separate outcomes, and after adjustment for competing risk of death.
PN, as measured by monofilament testing, is common in older adults and associated with risk of falls and fracture. Screening with monofilament testing may be warranted to identify older adults at high risk for falls.
在糖尿病患者中，每年使用单丝测试筛查周围神经病变（PN）是标准的护理方法。然而，即使没有糖尿病，老年人中也常见通过单丝测试检测到的 PN。我们旨在评估老年人 PN 与跌倒和骨折风险的关系。
我们纳入了在 ARIC 研究中接受单丝测试的参与者，该测试是在第 6 次访视（2016-2017 年）进行的。根据 ICD-9 和 ICD-10 代码从所有住院的主动监测以及与医疗保险索赔的链接中确定了跌倒和骨折的发生情况。我们使用 Cox 模型来评估 PN 与跌倒和骨折（综合和单独作为结局）的关系，同时调整了跌倒的危险因素。
共有 3617 名 ARIC 参与者（平均年龄 79.4[4.7]岁，40.8%为男性，21.4%为黑人成年人），其中 1242 人（34.3%）通过单丝测试患有 PN。在中位数为 2.5 年的随访期间，371 名参与者发生了记录在案的跌倒，475 名参与者发生了记录在案的骨折。患有 PN 的参与者与没有 PN 的参与者的跌倒或骨折的发生率（每 1000 人年）分别为 111.1 例和 74.3 例（p<0.001）。患有 PN 的参与者与没有 PN 的参与者的 3 年累积发生率明显更高，分别为 26.5%和 18.4%（p<0.001）。在调整了人口统计学因素后，PN 与跌倒和骨折仍独立相关（HR 1.48，95%CI 1.26，1.74）。当将跌倒和骨折作为单独的结局进行分析，并且调整了死亡的竞争风险时，结果是相似的。
通过单丝测试测量的 PN 在老年人中很常见，并且与跌倒和骨折的风险相关。使用单丝测试进行筛查可能有助于识别跌倒风险较高的老年人。
