高龄老人跌倒：性别、生活状况及辅助器具的作用
Falls in the oldest old: role of gender, living situation, and assistive devices.
作者信息
Colcord Katherine A, Jiang Luohua, Melikyan Zarui A, Al-Darsani Zeinah, Arnold Nikki Jagusch, Kristinsson Hayley B, Kawas Claudia H, Corrada María M
出版信息
Gerontology. 2025 Jun 25:1-20. doi: 10.1159/000547067.
BACKGROUND
Falls can have serious health consequences, especially in the oldest old (individuals 90+ years), for whom falls often result in injury or even death. Few studies have examined falls in the oldest old. We aim to assess fall prevalence, fall rate, and rate change over time according to gender, living situation, and assistive device use.
METHODS
Participants are from The 90+ Study, a longitudinal study of individuals 90 years and older with evaluations every 6 months. Participants, or their informants, were asked how many times they have fallen in the past year (first visit) or since their last visit (follow up visits). We calculated unadjusted baseline fall prevalence. Using generalized linear mixed regression models, we estimated adjusted baseline fall rate and adjusted change in rate over time by gender, living situation, and assistive device.
RESULTS
In 1672 participants (mean age 93 years, range 90-110 years), unadjusted baseline prevalence of 1+ falls was 47.9% in women and 47.8% in men. Estimated adjusted baseline fall rate was 0.66 falls per person year in women and 0.71 falls per person year in men. In women, fall rate did not change significantly over time, whereas in men, fall rate increased by an average of 6% per year. Both men and women in nursing homes had a higher fall rate compared with those in the community. In nursing homes, fall rate remained stable over time in men and decreased over time in women. Fall rate was higher in both men and women using assistive devices. However, walkers were associated with a decrease in fall rate over time in women and in participants in nursing homes. Canes were unexpectedly associated with an increase in fall rate over time.
CONCLUSIONS
Individuals 90 years and older had a high prevalence of falls overall. The higher and increasing rate of falls over time in men compared to women, suggests that efforts should be made to increase the uptake of fall prevention strategies specifically in men in the oldest age categories. The increasing fall rate in participants using canes suggests that referral to a health care provider trained in gait analysis prior to assistive device prescription could assist with fall prevention efforts in the oldest old.
背景
跌倒会产生严重的健康后果，尤其是在高龄老人（90岁及以上个体）中，跌倒往往会导致受伤甚至死亡。很少有研究对高龄老人的跌倒情况进行调查。我们旨在根据性别、生活状况和辅助设备使用情况评估跌倒患病率、跌倒发生率以及发生率随时间的变化。
方法
参与者来自“90 + 研究”，这是一项对90岁及以上个体进行的纵向研究，每6个月进行一次评估。询问参与者或其 informant 在过去一年（首次访视）或自上次访视以来（随访访视）跌倒的次数。我们计算了未调整的基线跌倒患病率。使用广义线性混合回归模型，我们按性别、生活状况和辅助设备估计了调整后的基线跌倒发生率以及发生率随时间的变化。
结果
在1672名参与者（平均年龄93岁，范围90 - 110岁）中，未调整的1次及以上跌倒的基线患病率在女性中为47.9%，在男性中为47.8%。估计调整后的基线跌倒发生率在女性中为每人每年0.66次跌倒，在男性中为每人每年0.71次跌倒。在女性中，跌倒发生率随时间没有显著变化，而在男性中，跌倒发生率平均每年增加6%。与社区中的男性和女性相比，养老院中的男性和女性跌倒发生率更高。在养老院中，男性的跌倒发生率随时间保持稳定，而女性的跌倒发生率随时间下降。使用辅助设备的男性和女性跌倒发生率都更高。然而，步行器与女性以及养老院中的参与者跌倒发生率随时间的下降有关。手杖出人意料地与跌倒发生率随时间的增加有关。
结论
90岁及以上的个体总体跌倒患病率较高。与女性相比，男性跌倒发生率随时间更高且呈上升趋势，这表明应努力提高特别是最年长年龄段男性对跌倒预防策略的采用率。使用手杖的参与者跌倒发生率上升表明，在开具辅助设备处方之前，转诊至接受过步态分析培训的医疗保健提供者，可能有助于高龄老人的跌倒预防工作。
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