Tromp A M, Smit J H, Deeg D J, Bouter L M, Lips P
Institute for Research in Extramural Medicine (EMGO Institute), Vrije Universiteit, Amsterdam, The Netherlands.
J Bone Miner Res. 1998 Dec;13(12):1932-9. doi: 10.1359/jbmr.1998.13.12.1932.
The objective of this study was to identify easily measurable predictors for falls, recurrent falls, and fractures using a population-based prospective cohort study of 1469 elderly, born before 1931, in three regions of the Netherlands. The baseline at-home interview was in 1992. In 1995, falls experienced in the preceding year and fractures over the preceding 38-month period were registered. In a period of 1 year, 32% of the participants fell at least once, and 15% fell two or more times. The rate of recurrent falls was similar in men and women up until the age of 75 years. The total number of fractures was 85, including 23 wrist fractures, 12 hip fractures, and 9 humerus fractures. The incidence density per 1000 person-years for any fracture was 25.1 (95% confidence interval [CI], 18.9-31.4) for women and 8.2 (95% CI, 4.5-12.0) for men, respectively. Multiple logistic regression identified urinary incontinence, impaired mobility, use of analgetics, and use of antiepileptic drugs as the predictors most strongly associated with recurrent falls. Female gender, living alone, past fractures, inactivity, body height, and use of analgetics proved to be the predictors most strongly associated with fractures. The probabilities of recurrent falls were 4.7% (95% CI, 2.9-7.5%) to 59. 2% (95% CI, 24.1-86.9%) with zero to four predictors, respectively. The probability of fractures ranged from 0.0% (95% CI, 0.0-0.4%) without any of the identified predictors to 12.9% (95% CI, 4.4-32. 2%) with all six predictors present. Our study shows that the risk of recurrent falls and of fractures can be predicted using up to, respectively, four and six easily measurable predictors. This study emphasizes the importance of impaired mobility and inactivity as predictors for falls and fractures.
本研究的目的是通过对荷兰三个地区1469名出生于1931年以前的老年人进行基于人群的前瞻性队列研究，确定易于测量的跌倒、反复跌倒和骨折的预测因素。1992年进行了基线居家访谈。1995年，记录了前一年发生的跌倒以及前38个月内发生的骨折情况。在1年的时间里，32%的参与者至少跌倒过一次，15%的参与者跌倒过两次或更多次。75岁之前，男性和女性反复跌倒的发生率相似。骨折总数为85例，其中腕部骨折23例，髋部骨折12例，肱骨骨折9例。女性和男性每1000人年任何骨折的发病密度分别为25.1（95%置信区间[CI]，18.9 - 31.4）和8.2（95%CI，4.5 - 12.0）。多因素逻辑回归分析确定尿失禁、行动能力受损、使用镇痛药和使用抗癫痫药物是与反复跌倒最密切相关的预测因素。女性、独居、既往骨折史、缺乏运动、身高以及使用镇痛药被证明是与骨折最密切相关的预测因素。有0至4个预测因素时，反复跌倒的概率分别为4.7%（95%CI，2.9 - 7.5%）至59.2%（95%CI，24.1 - 86.9%）。没有任何已确定的预测因素时骨折的概率为0.0%（95%CI，0.0 - 0.4%），存在所有六个预测因素时骨折的概率为12.9%（95%CI，4.4 - 32.2%）。我们的研究表明，分别使用多达四个和六个易于测量的预测因素可以预测反复跌倒和骨折的风险。本研究强调了行动能力受损和缺乏运动作为跌倒和骨折预测因素的重要性。
