Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?
Fear of falling in community-dwelling older adults: A cause of falls, a consequence, or both?
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DOI：
10.1371/journal.pone.0194967
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发表时间：
2018-03-29
期刊：
影响因子：
3.7
通讯作者：
Lavedan, Raquel
中科院分区：
文献类型：
--
作者：
Lavedan, Ana;Viladrosa, Maria;Lavedan, Raquel
背景尽管有大量研究试图证明以前跌倒与对跌倒的恐惧之间存在关联，但这两个变量之间的关系仍然存在争议。目标我们的目的是调查年龄 >= 75 岁的社区居民中，对跌倒的恐惧是否是跌倒的原因、结果或两者兼而有之。方法进行了一项描述性、纵向、前瞻性研究。 2009 年至 2011 年间，共有 640 人接受了采访。在基线和 24 个月时对社会人口统计数据、健康状况、跌倒史和跌倒恐惧进行了评估。结果基线跌倒发生率为 25%，而 24 个月时为 35.2%。基线时，害怕跌倒的患病率为 41.5%。逻辑回归分析显示跌倒史与跌倒恐惧之间存在显着关联。与跌倒恐惧相关的其他因素包括女性、合并症、抑郁症状和残疾。总共有 41.7% 的基线时表示害怕跌倒的受试者在 24 个月后至少经历过一次跌倒。未经调整的 Cox 回归分析显示，对跌倒的恐惧是跌倒的危险因素。根据调整其他协变量的最终模型，唯一可靠的预测因素是女性。按性别分层的 Cox 模型未能显示对跌倒的恐惧和跌倒之间的粗略关联。结论前一年的跌倒史可以很好地预测跌倒的恐惧；但只有在未经调整的模型中，对跌倒的恐惧才是随访期间跌倒的预测因素，这表明强烈的性别结果是 FOF 与随后跌倒之间关联的效应修正因子。从事老年护理工作的护理人员不仅应常规评估患者既往跌倒史，还应评估其对跌倒的恐惧及其相关因素。
BackgroundDespite the number of studies that have tried to demonstrate that there is an association between previous falls and the fear of falling, the relationship between these two variables remains a matter of controversy.ObjectivesOur objective was to investigate whether the fear of falling is a cause of falls, a consequence, or both in community-dwelling adults aged >= 75 years old.MethodsA descriptive, longitudinal, prospective study was performed. A total of 640 individuals were interviewed between 2009 and 2011. Sociodemographic data, health status, history of falls and fear of falling were assessed at baseline and at 24 months.ResultsThe prevalence of falls at baseline was 25% as opposed to 35.2% at 24 months. The prevalence of the fear of falling was 41.5% at baseline. Logistic regression analysis showed a significant association between a history of falls and the fear of falling. Other factors associated with the fear of falling were female gender, comorbidity, depressive symptoms, and disability. In total, 41.7% of the subjects who had reported a fear of falling at baseline had suffered at least one fall 24 months later. Unadjusted Cox regression analysis revealed that the fear of falling was a risk factor for falls. According to the final model adjusted for other covariates, the only reliable predictor was female gender. The Cox model stratified by gender failed to show a crude association between fear of falling and falls.ConclusionA previous history of falls in the previous year was a good predictor of the fear of falling; but the fear of falling was a predictor of falls during follow-up only in the unadjusted model, pointing to strong gender turns out as an effect modifier of the association of FOF and subsequent falls. Nursing staff working in elderly care should not only routinely assess patients' previous history of falls, but also evaluate their fear of falling and its associated factors.