Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention
Falls and fear of falling: Which comes first? A longitudinal prediction model suggests strategies for primary and secondary prevention
复制标题
DOI：
10.1046/j.1532-5415.2002.50352.x
复制
发表时间：
2002-08-01
影响因子：
6.3
通讯作者：
Fried, LP
中科院分区：
文献类型：
--
作者：
Friedman, SM;Munoz, B;Fried, LP
结论：以前的横断面研究表明，福尔斯和害怕摔倒之间存在相关性，但尚不清楚哪一个先出现。我们的目的是确定福尔斯和害怕跌倒之间的时间关系，并看看这两个结果是否共享predictors.Design：一项为期20个月的，以人群为基础的，前瞻性的，观察性研究。每个评估包括一个家庭管理的问卷调查，然后由4- 5小时的诊所evaluation.Participants：在索尔兹伯里眼睛评估项目的2,212名参与者谁有基线和20个月的后续临床评估。基线时，受试者年龄为65至84岁，居住在社区，并有一个简易精神状态检查评分为18或更高。测量：人口统计学，视觉功能，合并症，神经精神状态，药物使用，和身体性能为基础的措施进行了评估。采用逐步Logistic回归分析评估福尔斯和害怕跌倒的独立预测因素，首先预测事件结局，然后以基线跌倒和害怕跌倒作为预测因素预测20个月时的跌倒或害怕跌倒状态。（比值比（OR）= 1.75; P < .0005），基线时害怕跌倒是20个月时跌倒的预测因子（OR = 1.79; P < .0005）。有中风史的女性在随访时有福尔斯跌倒的风险和对跌倒的恐惧。此外，帕金森氏病，合并症，和白色种族预测福尔斯，而一般健康问卷评分，年龄，并采取四个或更多的药物预测falling.CONCLUSION：个人谁开发这些结果之一的风险是发展中国家的其他，从而导致螺旋上升的风险福尔斯，害怕跌倒，和功能下降。由于福尔斯和担心下降的份额预测，个人谁是在发展这些端点的高风险可以确定。
OBJECTIVES: Previous cross-sectional studies have shown a correlation between falls and fear of falling, but it is unclear which comes first. Our objectives were to determine the temporal relationship between falls and fear of falling, and to see whether these two outcomes share predictors.DESIGN: A 20-month, population-based, prospective, observational study.SETTING: Salisbury, Maryland. Each evaluation consisted of a home-administered questionnaire, followed by a 4- to 5-hour clinic evaluation.PARTICIPANTS: The 2,212 participants in the Salisbury Eye Evaluation project who had baseline and 20-month follow-up clinic evaluations. At baseline, subjects were aged 65 to 84 and community dwelling and had a Mini-Mental State Examination score of 18 or higher.MEASUREMENTS: Demographics, visual function, comorbidities, neuropsychiatric status, medication use, and physical performance-based measures were assessed. Stepwise logistic regression analyses were performed to evaluate independent predictors of falls and fear of falling at the follow-up evaluation, first predicting incident outcomes and then predicting fall or fear-of-falling status at 20 months with baseline falling and fear of falling as predictors.RESULTS: Falls at baseline were an independent predictor of developing fear of falling 20 months later (odds ratio (OR) = 1.75; P < .0005), and fear of falling at baseline was a predictor of falling at 20 months (OR = 1.79; P < .0005). Women with a history of stroke were at risk of falls and fear of falling at follow-up. In addition, Parkinson's disease, comorbidity, and white race predicted falls, whereas General Health Questionnaire score, age, and taking four or more medications predicted fear of falling.CONCLUSION: Individuals who develop one of these outcomes are at risk for developing the other, with a resulting spiraling risk of falls, fear of falling, and functional decline. Because falls and fear of falling share predictors, individuals who are at a high risk of developing these endpoints can be identified.