Sakai Yoshihito, Watanabe Tsuyoshi, Wakao Norimitsu, Matsui Hiroki, Osada Naoaki, Adachi Yui, Takeichi Yosuke, Katsumi Akira, Watanabe Ken
Department of Orthopedic Surgery, National Center for Geriatrics and Gerontology, Obu, Japan.
Department of Hematology, National Center for Geriatrics and Gerontology, Obu, Japan.
Geriatr Orthop Surg Rehabil. 2025 May 20;16:21514593251340758. doi: 10.1177/21514593251340758. eCollection 2025.
As walking ability and balance deteriorate with age for bipedal humans, ambulating independently becomes cumbersome without using walking aids. However, age-related risk factors for loss of independent walking ability are not well characterized. We aimed to analyze the clinically relevant factors for ambulatory device aid from the perspectives of nutrition, body composition, and postural abnormalities between independent and assisted walkers based on their ambulatory status.
Among the 3640 patients aged ≥65 years initially enrolled in the study, 1557 patients with a history of fragility fractures were excluded. Patients were categorized into those who could walk independently and those who required assistance. Body composition, including skeletal muscle mass index, whole-spine sagittal alignment, and blood biochemical findings, were compared.
Among the 2083 participants, 1323 and 760 were included in the independent and assisted groups, respectively. The logistic regression analysis identified five significant factors ( < 0.01): age, body mass index, red blood cell distribution width, skeletal muscle mass index, and sagittal vertical axis. The receiver operating characteristic analysis determined the threshold for assisted walking to be age 81.0 years, red blood cell distribution width of 14.0%, skeletal muscle mass index of 5.96 kg/m, and a sagittal vertical axis of 54.64 mm with areas under the curve of 0.727, 0.677, 0.645, and 0.708, respectively. Combining these four factors as propensity scores revealed an area under the curve of 0.768.
The comparison of independent and assisted walkers among older adults revealed the importance of age, red blood cell distribution width, skeletal muscle mass, and spinal sagittal balance as clinical factors of assisted walkers.
对于双足行走的人类而言，随着年龄增长，行走能力和平衡能力会逐渐下降，在不使用助行器的情况下独立行走会变得困难。然而，与年龄相关的独立行走能力丧失的风险因素尚未得到充分描述。我们旨在从营养、身体成分和姿势异常的角度，分析基于行走状态的独立行走者和需要辅助行走者之间使用助行器辅助的临床相关因素。
在最初纳入研究的3640名年龄≥65岁的患者中，排除了1557名有脆性骨折病史的患者。患者被分为能够独立行走的和需要辅助的两类。比较了包括骨骼肌质量指数、全脊柱矢状位排列和血液生化指标在内的身体成分。
在2083名参与者中，独立组和辅助组分别有1323名和760名。逻辑回归分析确定了五个显著因素（<0.01）：年龄、体重指数、红细胞分布宽度、骨骼肌质量指数和矢状垂直轴。受试者工作特征分析确定辅助行走的阈值为年龄81.0岁、红细胞分布宽度14.0%、骨骼肌质量指数5.96 kg/m和矢状垂直轴54.64 mm，曲线下面积分别为0.727、0.677、0.645和0.708。将这四个因素作为倾向得分进行综合分析，曲线下面积为0.768。
对老年人中独立行走者和辅助行走者的比较表明，年龄、红细胞分布宽度、骨骼肌质量和脊柱矢状位平衡作为辅助行走者的临床因素具有重要意义。
