Prevalence, risk factors, and burden of disease for falls and balance or walking problems among older adults in the US
Prevalence, risk factors, and burden of disease for falls and balance or walking problems among older adults in the US
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DOI：
10.1016/j.ypmed.2019.05.025
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发表时间：
2019-09-01
影响因子：
5.1
通讯作者：
Thompson, William W.
中科院分区：
文献类型：
--
作者：
Jia, Haomiao;Lubetkin, Erica, I;Thompson, William W.
这项研究评估了跌倒的患病率，预测未来跌倒的因素，以及跌倒对健康的影响以及美国老年人的平衡或行走问题。数据来自联邦医疗保险健康结果调查队列15中65岁的参与者(2012年的基线调查；2014年的跟踪调查；n=164,597)。我们检查了在随访时预测跌倒的基线因素，并评估了跌倒和平衡/行走问题对健康相关生活质量(HRQOL)、死亡率和质量调整生命年(QALY)的影响。在过去的12个月中，约23%的人报告摔倒，34%的人报告平衡/行走问题。跌倒的最强预测因素是既往跌倒[调整后的优势比(OR)=2.9]和平衡/行走问题(OR=1.7)。许多自我报告的慢性疾病(如抑郁症、中风和糖尿病)、老年症状(如尿漏)和日常生活活动受限(如转身和行走)也能预测跌倒，但幅度较小(OR=1.1-1.3)。有平衡/行走问题的人的生活质量得分(0.195分)比摔倒(0.077分)的下降幅度更大，而摔倒的死亡率[调整后的危险比(HR)=1.5%]比平衡/行走问题(HR=1.1%)的死亡率增加更大。跌倒与QALY下降4.6年(48%)有关，而平衡/行走问题与QALY下降7.3年(62%)有关。跌倒是美国老年人的主要问题，随着人口老龄化，跌倒将继续产生更大的影响。跌倒的QALY下降了近50%，平衡或行走问题的QALY下降了60%，这表明了美国老年人与这些问题相关的沉重负担。
This study assesses the prevalence of falls, factors predicting future falls, and health impacts of falls and balance or walking problems for U.S. older adults. Data were from participants >= 65 years in the Medicare Health Outcomes Survey Cohort 15 (baseline survey in 2012; follow-up survey in 2014; n = 164,597). We examined baseline factors predicting falls at follow-up and estimated the impact of falls and balance/walking problems on health-related quality of life (HRQOL), mortality, and quality-adjusted life years (QALYs). About 23% reported falls and 34% reported balance/walking problems in the past 12 months. The strongest predictors of falls were previous falls [adjusted odds ratio (OR) = 2.9] and balance/walking problems (OR = 1.7). Many self-reported chronic conditions (e.g., depression, stroke, and diabetes), geriatric symptoms (e.g., urine leakage), and limitations of activities of daily living (e.g., transferring and walking) also predicted falls, but at a smaller magnitude (ORs = 1.1-1.3). Having balance/walking problems was associated with a greater decrease in HRQOL scores (0.195 points) than falls (0.077 points), while falls were associated with a greater increase in mortality [adjusted hazard ratio (HR) = 1.5] than balance/walking problems (HR = 1.1). Falls were associated with a 4.6-year (48%) decrease in QALYs, while balance/walking problems was associated with a 7.3-year (62%) decrease in QALYs. Falls are a major problem for U.S. elderly and will continue to have an even greater impact as the population ages. The nearly 50% decrease in QALYs for falls and > 60% decrease for balance or walking problems demonstrates the substantial burden associated with these problems among older Americans.