Prediction of the Incidence of Falls and Deaths Among Elderly Nursing Home Residents: The SENIOR Study
Prediction of the Incidence of Falls and Deaths Among Elderly Nursing Home Residents: The SENIOR Study
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DOI：
10.1016/j.jamda.2017.06.014
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发表时间：
2018-01-01
影响因子：
7.6
通讯作者：
Bruyere, Olivier
中科院分区：
文献类型：
--
作者：
Buckinx, Fanny;Croisier, Jean-Louis;Bruyere, Olivier
目的：本研究的目的是评估疗养院居民中不同的衰弱操作定义对 1 年死亡率和跌倒的预测程度。方法：我们研究了来自老年疗养院个体样本的 662 名参与者：年龄 83.2 +/- 8.99 岁的观察研究 (SENIOR) 队列，其中包括 484 名 (72.5%) 居住在疗养院的女性。在该队列中，分别对 584 名和 565 名参与者进行了超过 12 个月的死亡率评估和跌倒发生情况（即通过他们的医疗记录）监测。每个患者都在基线时接受临床检查，在此期间收集了许多原始的临床特征。进行逐步回归分析来预测死亡率和跌倒情况。 结果：在研究的参与者中，在 1 年的随访期间，93 人（15.9%）死亡，211 人（37.3%）经历跌倒。调整后，评估的衰弱定义均无法预测一年内出现负面健康结果。当比较已故参与者和仍然活着的参与者的临床特征时，男性（OR = 1.89；95% CI：1.19-3.01；P = .002）和被诊断患有肌肉减少症（OR = 1.7；95% CI：1.1-2.92；P = .03）是与 1 年死亡率相关的独立因素。与 1 年跌倒发生率显着相关的其他独立因素包括 Tinetti 测试（OR = 0.93；95% CI：0.87-0.98；P = .04）、握力测试（OR = 0.95；95% CI：0.90-0.98，P = .03）以及肘伸肌等长力量测试（OR = 0.03）获得的结果。 0.93；95% CI：0.87-0.97；P = 0.04）。结论：在衰弱评估的操作定义中，没有足够的敏感性来预测疗养院居民一年内跌倒和死亡的发生率。在全球范围内，肌肉力量和活动能力较低的参与者出现不良健康结果的频率似乎更高。旨在提高特定等长肌肉力量和活动能力的医疗策略或适应性身体活动可能会显着减少跌倒甚至死亡的发生。 (C) 2017 AMDA - 急性后和长期护理医学协会。
Objective: The objective of this study was to evaluate, among nursing home residents, the extent to which the various operational definitions of frailty predict mortality and falls at 1 year.Methods: We studied 662 participants from the Sample of Elderly Nursing home Individuals: An Observational Research (SENIOR) cohort aged 83.2 +/- 8.99 years, including 484 (72.5%) women and living in nursing homes. Among this cohort, 584 and 565 participants, respectively, were monitored over 12 months for mortality assessment and for occurrence of falls (ie, by mean of their medical records). Each patient was subjected to a clinical examination at baseline, during which many original clinical characteristics were collected. Stepwise regression analyses were carried out to predict mortality and falls.Results: Among the participants included in the study, 93 (15.9%) died and 211 (37.3%) experienced a fall during the 1-year of follow-up. After adjustment, none of the definitions of frailty assessed predicted the 1-year occurrence of negative health outcomes. When comparing the clinical characteristics of deceased participants and those still alive, being a man (OR = 1.89; 95% CI: 1.19-3.01; P = .002) and being diagnosed with sarcopenia (OR = 1.7; 95% CI: 1.1-2.92; P = .03) were independent factors associated with 1-year mortality. Other independent factors that were significantly associated with the 1-year occurrence of falls were the results obtained with the Tinetti test (OR = 0.93; 95% CI: 0.87-0.98; P = .04), with the grip strength test (OR = 0.95; 95% CI: 0.90-0.98, P = .03), and with the isometric strength test of elbow extensors (OR = 0.93; 95% CI: 0.87-0.97; P = .04).Conclusions: Within the operational definitions of frailty assessed, none is sufficiently sensitive to predict the occurrence of falls and deaths at 1 year among nursing home residents. Globally, the frequency of undesirable health outcomes seems to be higher among participants with lower muscle strength and mobility. Medical strategy or adapted physical activity, with the aim of improving specific isometric muscle strength and mobility could potentially, but significantly, reduce the occurrence of falls and even deaths. (C) 2017 AMDA - The Society for Post-Acute and Long-Term Care Medicine.