Departments of Medicine and Geriatrics and Research Centre of the Geriatric University Institute of Montreal, University of Montreal, Montreal, QC, Canada.
Department of Medicine, Division of Geriatric Medicine, Sir Mortimer B. Davis Jewish General Hospital and Lady Davis Institute for Medical Research, McGill University, Montreal, QC, Canada.
Aging Clin Exp Res. 2023 May;35(5):1027-1032. doi: 10.1007/s40520-023-02392-0. Epub 2023 Mar 30.
This study aims to examine (1) the association of "Emergency Room Evaluation and Recommendations" (ER) cognitive and motor items with incident falls (i.e., ≥ 1), their recurrence (i.e., ≥ 2) and post-fall fractures and (2) the performance criteria (i.e., sensitivity, specificity) of the greater identified association for each incident fall outcome in older community dwellers.
7147 participants (80.5 ± 3.8; 100% female) of the EPIDémiologie de l'OStéoporose (EPIDOS) observational population-based cohort study were recruited in France. Inability to name the day's date and the use of a walking aid and/or an history of falls were recorded at baseline. Incident outcomes, which were ≥ 1 fall, ≥ 2 falls and post-fall fractures, were collected every 4 months over a period of 4 years.
The overall incidence of ≥ 1 fall was 26.4%, 6.4% for ≥ 2 falls, and 19.1% for post-fall fractures. Cox regressions revealed that the use of a walking aid and/or an history of falls [Hazard ratio (HR) ≥ 1.03 with P ≤ 0.011], inability to name the day's date (HR ≥ 1.05 with P ≤ 0.003), and their combination (HR ≥ 1.37 with P ≤ 0.002) were significantly associated with both incident falls, regardless of their recurrence, and post-fall fractures.
A significant positive association between ER cognitive and motor items, both, respectively, and in combination, with an overall incidence of falls, regardless of their recurrence, as well as with post-fall fractures was demonstrated. However, the low sensitivity and high specificity of the combination of ER items suggest that these items cannot be used for risk screening of fall outcomes in the older population.
本研究旨在检验（1）“急诊评估和建议”（ER）认知和运动项目与老年人社区居住者的跌倒事件（即≥1 次）、跌倒复发（即≥2 次）和跌倒后骨折的关联；以及（2）在识别出与每个跌倒事件结果的关联中，表现更好的性能标准（即敏感性、特异性）。
在法国招募了 EPIDémiologie de l'OStéoporose（EPIDOS）观察性、基于人群的队列研究的 7147 名参与者（80.5±3.8；100%女性）。在基线时记录了无法说出当天日期、使用助行器和/或有跌倒史。在 4 年的时间里，每 4 个月收集一次≥1 次跌倒、≥2 次跌倒和跌倒后骨折的事件结局。
≥1 次跌倒的总发生率为 26.4%，≥2 次跌倒的发生率为 6.4%，跌倒后骨折的发生率为 19.1%。Cox 回归显示，使用助行器和/或有跌倒史[风险比（HR）≥1.03，P≤0.011]、无法说出当天日期（HR≥1.05，P≤0.003），以及两者的组合（HR≥1.37，P≤0.002）与跌倒事件（无论其复发情况如何）以及跌倒后骨折均显著相关。
ER 认知和运动项目与跌倒事件的总体发生率之间存在显著的正相关，无论其复发情况如何，以及与跌倒后骨折之间存在显著的正相关。然而，ER 项目组合的低敏感性和高特异性表明，这些项目不能用于老年人跌倒结局的风险筛查。
