解释（准）虚弱老年人跌倒恐惧与健康相关生活质量之间关联的路径模型。

Path model explaining the association between fear of falling and health-related quality of life in (pre-)frail older adults.

作者信息

Sattler Tjard, Gottschalk Sophie, König Hans-Helmut, Braun Tobias, Büchele Gisela, Denkinger Michael, Fleiner Tim, Nerz Corinna, Rapp Kilian, Schäufele Martina, Werner Christian, Dams Judith

机构信息

Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Germany.

Hamburg Center for Health Economics, Hamburg, Germany.

出版信息

BMC Geriatr. 2025 Feb 7;25(1):87. doi: 10.1186/s12877-025-05718-x.

DOI:10.1186/s12877-025-05718-x

PMID:39920580

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11806603/

Abstract

BACKGROUND

Fear of falling (FoF) is estimated to be prevalent in over 50% of older adults and several studies suggest that it negatively affects health-related quality of life (HrQoL). Unlike previous studies that examined only few mediating variables, this study aimed to develop a more comprehensive path model explaining the association between FoF and HrQoL.

METHODS

A theoretical path model was developed based on existing evidence and expert feedback and fitted to cross-sectional baseline data on 385 community-dwelling (pre-)frail older adults from the PromeTheus randomized controlled trial using robust weighted least squares estimation. FoF and HrQoL were operationalized by the Short Falls Efficacy Scale International and EQ-5D Index, respectively. The model included potential explanatory pathways through physical activity (German Physical Activity Questionnaire for middle-aged and older adults), physical capacity (Short Physical Performance Battery), physical performance (Late-Life Function and Disability Instrument [LLFDI] function component), disability (LLFDI disability component - short form), and affect (visual analogue scales on 'happiness', 'sadness', 'calmness' and 'tension'). Age, sex, education, and previous falls were considered as covariates.

RESULTS

The model demonstrated good fit to the data and the remaining direct effect of FoF on HrQoL was small (β=-0.05). Physical capacity and physical performance were the most important mediators (combined indirect effect of β=-0.17, accounting for > 50% of the total effect). Pathways of minor individual relevance (e.g. through disability or affect) contributed considerably to the total indirect effect when combined. Controlling for sociodemographic data and previous falls only had minor effects on model fit and path coefficients.

CONCLUSION

Physical capacity and physical performance are particularly important levers for reducing the impact of FoF on HrQoL through interventions. However, the other pathways also had a considerable influence when taken together. Hence, research on the association of FoF and HrQol should acknowledge the complexity of causal pathways that may explain this association and not neglect minor pathways. The proposed model should be tested on an alternative sample, using longitudinal data, and extended to include additional explanatory factors (e.g. activity avoidance).

TRIAL REGISTRATION

German Clinical Trials Register, ID: DRKS00024638, https://drks.de/search/en/trial/DRKS00024638 , date of registration: March 11th 2021.

摘要

背景

据估计，超过50%的老年人存在跌倒恐惧（FoF），多项研究表明，这会对健康相关生活质量（HrQoL）产生负面影响。与以往仅研究少数中介变量的研究不同，本研究旨在构建一个更全面的路径模型，以解释FoF与HrQoL之间的关联。

方法

基于现有证据和专家反馈构建了一个理论路径模型，并使用稳健加权最小二乘法估计，将其应用于来自普罗米修斯随机对照试验的385名社区居住的（预）衰弱老年人的横断面基线数据。FoF和HrQoL分别通过国际简短跌倒效能量表和EQ-5D指数进行量化。该模型包括通过身体活动（德国中老年人体力活动问卷）、身体能力（简短身体性能测试）、身体表现（晚年功能与残疾量表[LLFDI]功能部分）、残疾（LLFDI残疾部分 - 简表）和情感（关于“幸福”“悲伤”“平静”和“紧张”的视觉模拟量表）的潜在解释路径。年龄、性别、教育程度和既往跌倒情况被视为协变量。

结果

该模型与数据拟合良好，FoF对HrQoL的剩余直接效应较小（β=-0.05）。身体能力和身体表现是最重要的中介因素（联合间接效应β=-0.17，占总效应的50%以上）。个体相关性较小的路径（如通过残疾或情感）在合并时对总间接效应有相当大的贡献。控制社会人口学数据和既往跌倒情况对模型拟合和路径系数的影响较小。

结论

身体能力和身体表现是通过干预减少FoF对HrQoL影响的特别重要的杠杆。然而，其他路径合并起来也有相当大的影响。因此，关于FoF与HrQol关联的研究应认识到可能解释这种关联的因果路径的复杂性，而不应忽视次要路径。应在另一个样本上使用纵向数据对所提出的模型进行测试，并扩展以纳入其他解释因素（如活动回避）。