Transfer bias and the association of cognitive impairment with falls.
Transfer bias and the association of cognitive impairment with falls.
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转移偏差以及认知障碍与跌倒的关联。
DOI：
10.1007/bf02596341
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发表时间：
1988
影响因子：
5.7
通讯作者：
Larson,EB
中科院分区：
文献类型：
--
作者：
Buchner,DM;Larson,EB
作者假设认知障碍与老年人的福尔斯有关，但在横断面社区研究中，转移偏倚可能会掩盖这种关联。如果失智症患者因死亡或住院而相对无法接受社区调查，则会出现偏倚。为了验证这一假设，我们使用一项对157名阿尔茨海默型痴呆患者进行的纵向队列研究的数据，对福尔斯和认知障碍之间的“剂量-反应”关系进行了检验。在基线数据的横断面分析中，当96%的队列是社区居民时，福尔斯和认知障碍之间的关联不显著（简易精神状态评分10分变化的比值比=1.2，95%置信区间0.76-1.9）。然而，基线时的认知障碍预测了3年随访期间的福尔斯（OR=1.8，95% CI 1.1-3.0）。痴呆的严重程度和福尔斯都是死亡或住院的危险因素。随访期间离开社区风险最高的患者是那些无法行走的患者。根据纵向数据，作者得出结论，认知障碍和福尔斯之间存在剂量反应效应。转移偏倚可能掩盖了基线时的相关性。这些数据强调了对福尔斯进行前瞻性研究的重要性。
The authors hypothesized that cognitive impairment is associated with falls in older adults, but that transfer bias may obscure this association in cross-sectional community studies. The bias would arise if demented patients who fall are relatively unavailable to community surveys due to death or institutionalization. To test this hypothesis, a “dose-response” relationship between falls and cognitive impairment was tested for using data from a longitudinal cohort study of 157 patients with Alzheimer-type dementia. In a cross-sectional analysis of baseline data, when 96% of the cohort were community residents, the association between falls and cognitive impairment was insignificant (odds ratio for a 10-point change in Mini-mental State score =1.2, 95% confidence interval 0.76–1.9). Yet cognitive impairment at baseline predicted falls during three-year follow-up (OR=1.8, 95% CI 1.1–3.0). Both severity of dementia and falls were risk factors for death or institutionalization. Patients at highest risk for leaving the community during follow-up were those who became non-ambulatory. The authors conclude, based on longitudinal data, that there is a dose-response effect between cognitive impairment and falls. Transfer bias probably obscured the association at baseline. These data emphasize the importance of prospective studies of falls.