Tinetti M E, Inouye S K, Gill T M, Doucette J T
Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06520-8025, USA.
JAMA. 1995 May 3;273(17):1348-53.
To determine whether a set of factors representing impairments in multiple areas could be identified that predisposes to falling, incontinence, and functional dependence.
Population-based cohort with a 1-year follow-up.
General community.
A total of 927 New Haven, Conn, residents, aged 72 years and older who completed the baseline and 1-year interviews.
At least one episode of urinary incontinence per week, at least two falls during the follow-up year, and dependence on human help for one or more basic activities of daily living.
At 1 year, urinary incontinence was reported by 16%, at least two falls by 10%, and functional dependence by 20% of participants. The four independent predisposing factors for the outcomes of incontinence, falling, and functional dependence included slow timed chair stands (lower extremity impairment), decreased arm strength (upper extremity impairment), decreased vision and hearing (sensory impairment), and either a high anxiety or depression score (affective impairment). There was a significant increase in each of incontinence, falling, and functional dependence as the number of these predisposing factors increased. For example, the proportion of participants experiencing functional dependence doubled (7% to 14% to 28% to 60%) (chi 2 = 119.8; P < .001) as the number of predisposing factors increased from zero to one to two at least three.
Our findings suggest that predisposition to geriatric syndromes and functional dependence may result when impairments in multiple domains compromise compensatory ability. It may be possible to restore compensatory ability and prevent or delay the onset of several geriatric syndromes and, perhaps, functional dependence by modifying a shared set of predisposing factors. Perhaps it is time to take a more unified approach to the geriatric syndromes and functional dependence.
确定是否能识别出一组代表多个领域功能障碍的因素，这些因素会使人易发生跌倒、失禁和功能依赖。
基于人群的队列研究，随访1年。
普通社区。
共927名康涅狄格州纽黑文市72岁及以上的居民，他们完成了基线访谈和1年随访访谈。
每周至少发生一次尿失禁、随访年度内至少跌倒两次、在一项或多项日常生活基本活动中依赖他人帮助。
1年后，16%的参与者报告有尿失禁，10%的参与者至少跌倒两次，20%的参与者存在功能依赖。导致失禁、跌倒和功能依赖结果的四个独立易感因素包括从椅子上缓慢站起（下肢功能障碍）、手臂力量下降（上肢功能障碍）、视力和听力下降（感觉功能障碍）以及焦虑或抑郁评分高（情感功能障碍）。随着这些易感因素数量的增加，失禁、跌倒和功能依赖的发生率均显著上升。例如，随着易感因素数量从0增加到1、到2至少到3，存在功能依赖的参与者比例翻倍（7%至14%至28%至60%）（χ² = 119.8；P < 0.001）。
我们的研究结果表明，当多个领域的功能障碍损害代偿能力时，可能会导致老年综合征和功能依赖的易感性。通过改变一组共同的易感因素，有可能恢复代偿能力，预防或延迟几种老年综合征的发生，或许还能预防功能依赖。也许是时候对老年综合征和功能依赖采取更统一的方法了。
