Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors: the Longitudinal Ageing Study Amsterdam
Older individuals with diabetes have an increased risk of recurrent falls: analysis of potential mediating factors: the Longitudinal Ageing Study Amsterdam
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DOI：
10.1093/ageing/afr145
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发表时间：
2012-05-01
期刊：
影响因子：
6.7
通讯作者：
Kruseman, Arie C. Nieuwenhuijzen
中科院分区：
文献类型：
--
作者：
Pijpers, Evelien;Ferreira, Isabel;Kruseman, Arie C. Nieuwenhuijzen
方法：对来自阿姆斯特丹纵向老龄化研究(LASA)的1,145名(85名糖尿病患者)社区参与者进行基于人群的队列研究，年龄=65岁。在3年的随访期内(每隔3个月)对跌倒进行前瞻性评估。用Poisson回归分析估计再跌倒的发生率。结果：在平均139周的随访中，30.6%的糖尿病患者和19.4%的非糖尿病患者反复跌倒[每千人年的发病率分别为129.7和77.4%，HR=1.67(95%CI：1.11-2.51)]。对潜在混杂因素的调整并没有改变与糖尿病相关的风险增加[HR=1.63(1.06-2.52)]。部分解释这种风险增加的因素是：更多的药物治疗，更高的疼痛水平，更差的自我感觉健康，更少的体力活动和握力，更多的ADL限制，下肢体能表现和认知障碍。这些变量加在一起，与糖尿病相关的复发性跌倒风险增加的47%相似[调整后的HR=1.30(0.79-2.11)]。结论：针对上述确定的因素的预防跌倒努力可能需要纳入老年糖尿病患者的护理和治疗。
Methods: population-based cohort study of 1,145 (85 with diabetes) community-dwelling participants, aged >= 65 years, from The Longitudinal Aging Study Amsterdam (LASA). Falls were assessed prospectively (every 3 months) during a 3-year follow-up period. Incidence of recurrent falls was estimated with Poisson regression analyses. The associations between diabetes and time to recurrent falls, defined as at least two falls occurring within a 6-month period, and the potential explanatory role of several risk factors herein, were analysed with the use of Cox-regression models.Results: during a mean follow-up of 139 weeks, 30.6% of the individuals with and 19.4% of the individuals without diabetes fell recurrently [incidence rate of 129.7 versus 77.4 per 1,000 persons-years, respectively, HR = 1.67 (95% CI: 1.11-2.51)]. Adjustments for potential confounders did not change the increased risk associated with diabetes [HR = 1.63 (1.06-2.52)]. Factors that partly explained this increased risk were: greater number of medication, higher levels of pain, poorer self-perceived health, lower physical activity and grip strength, more limitations in ADLs, lower-extremity physical performance and cognitive impairment. Altogether, these variables accounted for similar to 47% of the increased risk of recurrent falls associated with diabetes [adjusted HR = 1.30 (0.79-2.11)].Conclusion: fall prevention efforts targeting the factors identified above may need to be incorporated into the care and treatment of older individuals with diabetes.