Musculoskeletal pain and risk for falls in older disabled women living in the community
Musculoskeletal pain and risk for falls in older disabled women living in the community
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DOI：
10.1046/j.1532-5415.2002.50161.x
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发表时间：
2002-04-01
影响因子：
6.3
通讯作者：
Guralnik, JM
中科院分区：
文献类型：
--
作者：
Leveille, SG;Bean, J;Guralnik, JM
目的：确定肌肉骨骼疼痛是否增加老年残疾妇女福尔斯跌倒的风险。设计：前瞻性人群队列研究。地点：巴尔的摩东部地区的市县。参与者：1 002名65岁及以上的妇女参加了妇女健康和老龄化研究，占生活在家中的残疾老年妇女的三分之一，从1991年开始，每半年随访3年。测量：根据疼痛的严重程度和部位，将疼痛分为4组。广泛性疼痛定义为上肢和下肢以及中轴骨骼区域的疼痛，至少一个区域出现中度至重度疼痛（10分制数字评定量表中大于或等于4分，10 =极度疼痛）。不符合广泛疼痛标准的中度至重度下肢疼痛是下一个类别。参考类别为一个部位无疼痛或轻度疼痛。“其他疼痛”的额外类别是不适合其他三组的疼痛。福尔斯和下降相关的伤害的发生进行了评估，在每个interview.Results：940名妇女参加了至少一个后续检查，39%下降，在第一年的幸存者，36%下降，在第二年，39%在第三年。在调整了福尔斯的几个主要危险因素后，与那些只有一个肌肉骨骼部位没有或轻微疼痛的女性相比，广泛疼痛的女性在随访期间跌倒的可能性增加（调整后的比值比（AOR）= 1.66，5%置信区间（CI）= 1.25-2.21）。有其他肌肉骨骼疼痛但没有广泛疼痛或下肢疼痛的女性也有福尔斯跌倒的风险增加（AOR = 1.36，95% CI = 1.021.82）。在肌肉骨骼疼痛的女性中，每日使用止痛药的女性发生福尔斯的风险较低。风险复发福尔斯和自我报告的骨折，由于福尔斯也升高的妇女肌肉骨骼疼痛，最一致的妇女广泛pain.CONCLUSIONS：肌肉骨骼疼痛，特别是广泛的疼痛，是一个重大的危险因素福尔斯在老年妇女残疾。这些发现为我们理解导致老年人福尔斯跌倒的多因素过程增加了一个重要方面。
OBJECTIVES: To determine whether musculoskeletal pain increased risk for falls in older women with disabilities.DESIGN: Prospective population-based cohort study.SETTING: The city and county of the eastern area of Baltimore.PARTICIPANTS: One thousand two women aged 65 and older, participants in the Women's Health and Aging Study, representing the one-third of older women who were living at home with disabilities, followed semiannually for 3 years beginning in 1991.MEASUREMENTS: Pain was categorized into four groups according to severity and location. Widespread pain was defined as pain in the upper and lower extremities and in the axial skeletal region, with moderate to severe pain in at least one region ( greater than or equal to 4 on a 10-point numeric rating scale, 10 = excruciating pain). Moderate to severe lower extremity pain that did not meet criteria for widespread pain was the next category. The reference category was no pain or mild pain in one site. The additional category of "other pain" was pain that did not fit into the other three groups. The occurrence of falls and fall-related injuries were assessed at each interview.RESULTS: Of the 940 women who participated in at least one follow-up examination, 39% fell in first year; of the survivors, 36% fell in Year 2, and 39% in Year 3. After adjusting for several major risk factors for falls, women with widespread pain had an increased likelihood of falling during follow-up (adjusted odds ratio (AOR) = 1.66, 5% confidence interval (CI) = 1.25-2.21) compared with those with no or mild pain in only one musculoskeletal site. Women who had other musculoskeletal pain but not widespread pain or lower extremity pain also had an increased risk of falls (AOR = 1.36, 95% CI = 1.021.82). Among women with musculoskeletal pain, risk for falls was lower in those who used daily analgesic medication. Risk for recurrent falls and self-reported fractures due to falls was also elevated in women with musculoskeletal pain, most consistently in women with widespread pain.CONCLUSIONS: Musculoskeletal pain, particularly widespread pain, is a substantial risk factor for falls in older women with disabilities. These findings add an important dimension to our understanding of the multifactorial processes leading to falls in older persons.