Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes.
Shared risk factors for falls, incontinence, and functional dependence. Unifying the approach to geriatric syndromes.
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DOI：
10.1001/jama.1995.03520410042024
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发表时间：
1995-05
期刊：
影响因子：
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通讯作者：
M. Tinetti;S. Inouye;T. Gill;J. Doucette
中科院分区：
文献类型：
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作者：
M. Tinetti;S. Inouye;T. Gill;J. Doucette
目的确定是否可以识别一组代表多个区域损伤的因素，这些因素易导致跌倒、失禁和功能依赖。设计：基于人群的队列研究，随访1年。设置一般社区。参与者共927名纽黑文，康涅狄格州，居民，年龄72岁及以上谁完成了基线和1年的采访。主要观察指标：每周至少有一次尿失禁，随访一年中至少有两次福尔斯跌倒，以及一种或多种基本日常生活活动依赖人类帮助。结果在1年时，尿失禁的报告率为16%，至少有两次福尔斯的报告率为10%，功能依赖的报告率为20%。尿失禁、跌倒和功能依赖性结局的4个独立诱发因素包括缓慢的椅子站立（下肢损伤）、手臂力量下降（上肢损伤）、视力和听力下降（感觉损伤）以及焦虑或抑郁评分较高（情感损伤）。随着这些诱发因素的增加，尿失禁、跌倒和功能依赖性均显著增加。例如，当诱发因素从0增加到1，再到2，至少3时，经历功能性依赖的参与者比例翻了一番（7%到14%到28%到60%）（卡方= 119.8; P <0.001）。结论：我们的研究结果表明，当多个领域的损害损害代偿能力时，可能导致老年综合征和功能依赖的易感性。通过改变一系列共同的诱发因素，有可能恢复代偿能力并预防或延迟几种老年综合症的发生，也许还可以预防或延迟功能性依赖的发生。也许现在是时候采取一个更统一的方法来处理老年综合征和功能依赖。
OBJECTIVE To determine whether a set of factors representing impairments in multiple areas could be identified that predisposes to falling, incontinence, and functional dependence. DESIGN Population-based cohort with a 1-year follow-up. SETTING General community. PARTICIPANTS A total of 927 New Haven, Conn, residents, aged 72 years and older who completed the baseline and 1-year interviews. MAIN OUTCOME MEASURES At least one episode of urinary incontinence per week, at least two falls during the follow-up year, and dependence on human help for one or more basic activities of daily living. RESULTS At 1 year, urinary incontinence was reported by 16%, at least two falls by 10%, and functional dependence by 20% of participants. The four independent predisposing factors for the outcomes of incontinence, falling, and functional dependence included slow timed chair stands (lower extremity impairment), decreased arm strength (upper extremity impairment), decreased vision and hearing (sensory impairment), and either a high anxiety or depression score (affective impairment). There was a significant increase in each of incontinence, falling, and functional dependence as the number of these predisposing factors increased. For example, the proportion of participants experiencing functional dependence doubled (7% to 14% to 28% to 60%) (chi 2 = 119.8; P < .001) as the number of predisposing factors increased from zero to one to two at least three. CONCLUSIONS Our findings suggest that predisposition to geriatric syndromes and functional dependence may result when impairments in multiple domains compromise compensatory ability. It may be possible to restore compensatory ability and prevent or delay the onset of several geriatric syndromes and, perhaps, functional dependence by modifying a shared set of predisposing factors. Perhaps it is time to take a more unified approach to the geriatric syndromes and functional dependence.