Quantitative Gait Markers and Incident Fall Risk in Older Adults
Quantitative Gait Markers and Incident Fall Risk in Older Adults
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DOI：
10.1093/gerona/glp033
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发表时间：
2009-08-01
影响因子：
5.1
通讯作者：
Wang, Cuiling
中科院分区：
文献类型：
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作者：
Verghese, Joe;Holtzer, Roee;Wang, Cuiling
识别老年人跌倒的定量步态标志可以改善诊断评估并提出新的干预目标。我们研究了597名年龄在70岁及以上的成年人（平均年龄80.5岁，62%为女性），他们在基线时接受了定量步态评估。采用广义估计方程程序对年龄、性别、教育程度、跌倒、慢性疾病、药物、认知、残疾以及步态和平衡的传统临床测试进行调整，研究速度和其他六种步态标志（节奏、步幅、摆动、双支撑、步幅变异性和摆动时间变异性）与意外跌倒率的关系。在平均20个月的随访期间，597名参与者中有226人（38%）下降。平均下降率为0.44人/年。在完全调整的模型中，较慢的步态速度（每10厘米/秒下降的风险比[RR]为1.069,95%可信区间[CI]为1.001-1.142）与较高的跌倒风险相关。在其他6项指标中，较差的挥杆表现（RR 1.406, 95% CI 1.027-1.926）、双支持期（RR 1.165, 95% CI 1.026-1.321）、挥杆时间变异性（RR 1.007, 95% CI 1.004-1.010）和步幅变异性（RR 1.076, 95% CI 1.030-1.111）预示着跌倒风险。即使在考虑了认知障碍和残疾因素后，这种联系仍然很重要。定量步态标志是老年人跌倒的独立预测因素。应该进一步研究步态速度和其他指标，特别是变异性，以改进目前的跌倒风险评估并开发新的干预措施。
Identifying quantitative gait markers of falls in older adults may improve diagnostic assessments and suggest novel intervention targets.We studied 597 adults aged 70 and older (mean age 80.5 years, 62% women) enrolled in an aging study who received quantitative gait assessments at baseline. Association of speed and six other gait markers (cadence, stride length, swing, double support, stride length variability, and swing time variability) with incident fall rate was studied using generalized estimation equation procedures adjusted for age, sex, education, falls, chronic illnesses, medications, cognition, disability as well as traditional clinical tests of gait and balance.Over a mean follow-up period of 20 months, 226 (38%) of the 597 participants fell. Mean fall rate was 0.44 per person-year. Slower gait speed (risk ratio [RR] per 10 cm/s decrease 1.069, 95% confidence interval [CI] 1.001-1.142) was associated with higher risk of falls in the fully adjusted models. Among six other markers, worse performance on swing (RR 1.406, 95% CI 1.027-1.926), double-support phase (RR 1.165, 95% CI 1.026-1.321), swing time variability (RR 1.007, 95% CI 1.004-1.010), and stride length variability (RR 1.076, 95% CI 1.030-1.111) predicted fall risk. The associations remained significant even after accounting for cognitive impairment and disability.Quantitative gait markers are independent predictors of falls in older adults. Gait speed and other markers, especially variability, should be further studied to improve current fall risk assessments and to develop new interventions.