The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, D02 R590, Ireland.
Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SZ, UK.
Age Ageing. 2023 Mar 1;52(3). doi: 10.1093/ageing/afad037.
The label 'faller' and the associated stigma may reduce healthcare-seeking behaviours. However, falls are not inevitably progressive and many drivers are modifiable. This observational study described the 8-year longitudinal trajectories of self-reported falls in The Irish Longitudinal Study on Ageing (TILDA) and studied associations with factors, including mobility, cognition, orthostatic hypotension (OH), fear of falling (FOF) and use of antihypertensive and antidepressant medications.
Participants aged ≥50 years at each wave were categorised by whether they averaged ≥2 falls in the previous year (recurrent fallers) or not (≤1 fall). Next-wave transition probabilities were estimated with multi-state models.
8,157 (54.2% female) participants were included, of whom 586 reported ≥2 falls at Wave 1. Those reporting ≥2 falls in the past year had a 63% probability of moving to the more favourable state of ≤1 fall. Those reporting ≤1 fall had a 2% probability of transitioning to ≥2 falls. Besides older age and higher number of chronic conditions, factors that increased the risk of transitioning from ≤1 fall to ≥2 falls were lower Montreal Cognitive Assessment score, FOF and taking antidepressants. Conversely, male sex, higher timed up and go time, the presence of OH and being on antidepressants reduced the probability of improving from ≥2 falls to ≤1 fall.
The majority of recurrent fallers experienced favourable transitions. Improvements in cognitive and psychological status, psychotropic prescribing, mobility and OH may help improve trajectories. Findings may help combat stigma associated with falling and promote preventative healthcare-seeking behaviours.
“跌倒者”的标签及其相关污名将减少医疗保健的寻求行为。然而，跌倒并非必然会持续发展，许多因素是可以改变的。本观察性研究描述了在爱尔兰老龄化纵向研究（TILDA）中自我报告跌倒的 8 年纵向轨迹，并研究了与移动能力、认知、体位性低血压（OH）、跌倒恐惧（FOF）以及使用抗高血压药和抗抑郁药相关的因素的关联。
在每一波中，年龄均≥50 岁的参与者根据他们在前一年中是否平均报告≥2 次跌倒（复发性跌倒者）或≤1 次跌倒（≤1 次跌倒者）进行分类。使用多状态模型估计下一阶段的转移概率。
共纳入 8157 名（54.2%为女性）参与者，其中 586 名参与者在第 1 波中报告≥2 次跌倒。在过去一年中报告≥2 次跌倒的人有 63%的可能性转移到≤1 次跌倒的更有利状态。报告≤1 次跌倒的人有 2%的可能过渡到≥2 次跌倒。除了年龄较大和患有更多慢性疾病外，增加从≤1 次跌倒转移到≥2 次跌倒风险的因素是较低的蒙特利尔认知评估评分、FOF 和服用抗抑郁药。相反，男性、更高的计时起立行走时间、存在 OH 和服用抗抑郁药会降低从≥2 次跌倒改善到≤1 次跌倒的概率。
大多数复发性跌倒者经历了有利的转变。认知和心理状态、精神科药物的使用、移动能力和 OH 的改善可能有助于改善轨迹。这些发现可能有助于消除与跌倒相关的污名，并促进预防性医疗保健的寻求行为。
