社区55岁及以上人群轻度认知功能障碍与跌倒风险的关联研究

孙晓娅; 贺志强; 王立群; 王志忠

doi:10.16462/j.cnki.zhjbkz.2020.02.015

社区55岁及以上人群轻度认知功能障碍与跌倒风险的关联研究

doi: 10.16462/j.cnki.zhjbkz.2020.02.015

750004 银川, 宁夏医科大学公共卫生与管理学院流行病与卫生统计学系

基金项目: 国家自然基金课题(81860599)

详细信息

通讯作者:
王志忠, E-mail:wzhzh_lion@126.com

中图分类号: R749.16
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出版历程
- 收稿日期: 2019-07-09
- 修回日期: 2019-10-08
- 刊出日期: 2020-02-10

Association of mild cognitive impairment with incidence of falls in communities aged 55 and over

School of Public Health and Management, Ningxia Medical University, Yinchuan 75000, China

Funds: National Natural Science Foundation Project(81860599)

More Information

Corresponding author: WANG Zhi-zhong, E-mail:wzhzh_lion@126.com

摘要

摘要: 目的探讨轻度认知功能障碍(mild cognitive impairment, MCI)与社区人群跌倒风险的关联, 为预防老年人跌倒提供参考。方法 2015年9月, 对宁夏吴忠市参加基本公共卫生体检的826名55岁及以上社区人群进行认知功能测评, 2016年3月期间(6个月后)通过电话随访调查跌倒发生情况并比较不同人群跌倒发生率; 采用非条件Logistic回归分析模型分析跌倒与轻度认知功能障碍的相关性。结果共有521人完成了随访, 其中MCI组127人。2015年9月~2016年3月期间, 共有32人报告发生跌倒, 发生率为6.1%(32/521), 其中女性跌倒发生率(8.85%, 23/260)高于男性(3.45%, 9/261), 两组差异有统计学意义(RR=2.56, P=0.010)。MCI组发生率(9.45%, 12/127)是非MCI组的1.86倍, 差异具有统计学意义(RR=1.86, P=0.073);多因素分析控制了性别、年龄和文化程度等人口学变量后, MCI与跌倒发生风险无明显性关联(OR=1.41, P=0.382)。结论社区老年人群跌倒发生率较高, 且女性高于男性; 尚未观察到MCI与人群跌倒发生风险明显相关, 需要今后大样本人群研究进一步验证。
- 跌倒 /
- 轻度认知功能障碍 /
- 相关性 /
- 队列研究
Abstract: Objective To explore the association between mild cognitive impairment(MCI) and the risk of falls in community populations, so as to provide a reference for preventing falls in the elderly. Methods 826 community residents aged 55 years and older were enrolled in Wuzhong, Ningxia; cognitive function was assessed during the participants attending the basic public health examination, and self-report falling events were observed through telephone call survey after half a year. The incidence of falls among different populations was compared using unconditional Logistic regression model. Results A total of 521 participants completed the follow-up study, and 127 of them met criteria of MCI at baseline. 32 participants reported falling occurred during follow-up with a incidence of 6.1%(32/521), and the incidence of falls was higher(8.85%, 23/260) in females than that of males(3.45%, 9/261)(RR=2.56, P=0.010). The incidence among MCI group(9.45%, 12/127) was 1.86 times of that among non-MCI group(RR=1.86, P=0.073). Under the controlling of demographic variables(gender, age and education level), there was no association between MCI and falls(RR=1.41, P=0.382). Conclusions The incidence of falls in the elderly communities is common, and females has higher risk of falls than males. There is no statistical association between MCI and risk of falls. Further validation is needed with large-sample studies in the future.
- Fall /
- Mild cognitive impairment /
- Correlation /
- Cohort study

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表 1 MCI组和非MCI组一般人口学特征比较(n=521)

Table 1. Comparison of general demographic characteristics of MCI group and non-MCI group (n=521)

分组	MCI组	非MCI组	t/χ²值	P值
性别			47.08	< 0.001
男	30	231
女	97	163
年龄(岁)[4]			0.11	0.732
≤65	76	229
> 65	51	165
文化程度			9.92	0.002
小学和文盲	119	324
初中及以上	8	70
独居			0.01	0.905
是	8	26
否	119	368
ADL得分(x±s)	14.09±0.30	14.22±1.40	0.315	0.523
GDS得分(x±s)	15.53±3.40	14.55±2.64	-2.100	0.068
MMSE得分(x±s)	24.01±3.44	15.50±3.40	14.400	0.097

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表 2 社区人群跌倒发生率的分布特征[n(%)]

Table 2. Distribution characteristics of falls in community population [n(%)]

分组	随访人数(人)	n(%)	发生率%(95% CI)值	RR值	U值	P值
认知功能				1.86	1.78	0.073
MCI	127	12(9.45)	9.45(4.30~14.60)
非MCI	394	20(5.10)	5.10(2.90~7.30)
性别				2.56	6.58	0.010
女	260	23(8.85)	8.85(5.40~12.30)
男	261	9(3.45)	3.45(1.20~5.70)
年龄(岁)				1.03	0.01	0.921
≤65	305	19(6.23)	6.23(3.50~9.00)
> 65	216	13(6.02)	6.02(2.80~9.20)
文化程度				2.64	2.03	0.154
小学和文盲	443	30(6.77)	6.77(4.40~9.10)
初中及以上	78	2(2.56)	2.60	-	-	-
独居				2.16	-	0.713
否	487	31(6.37)	6.37(4.20~8.50)
是	34	1(2.94)	2.94	-	-
注:-样本例数太少, 未计算可信区间。

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表 3 社区人群跌倒发生率影响因素的非条件Logistics回归分析

Table 3. Unconditional Logistic regression analysis of factors affecting the fall rate of community population

变量	β	s_x	OR(95% CI)值	wald值	P值
常数项	-6.17	2.59	-	5.66	0.017
MCI	0.35	0.40	1.41(0.64~3.11)	0.76	0.382
文化程度	-0.50	0.78	0.60(0.13~2.81)	0.40	0.522
年龄组	0.15	0.38	1.17(0.55~2.49)	0.16	0.682
性别	0.86	0.45	2.38(0.98~5.77)	3.67	0.055
独居	0.99	1.03	2.69(0.35~20.58)	0.90	0.340

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参考文献(20)

[1]	World Health Organization. Dementia: a public health priority[M]. Geneva: World Health Organization, 2012, 123-125.
[2]	聂晓璐, 吕晓珍, 卓琳, 等. 2001-2015年中国轻度认知功能障碍患病率的Meta分析[J].中华精神科杂志, 2016, 49(5): 298-306. DOI: 10.3760/cma.j.issn.1006-7884.2016.05.006. Nie XL, Lü XZ, Zhuo L, et al. Meta-analysis of the prevalence of mild cognitive impairment in China from 2001 to 2015[J]. Chinese Journal of Psychiatry, 2016, 49(5): 298-306. DOI: 10.3760/cma.j.issn.1006-7884.2016.05.006.
[3]	Wilson RS, Barnes LL, Mendes de Leon CF, et al. Depressive symptoms, cognitive decline, and risk of AD in older persons[J]. Neurology, 2002, 59(3): 364-370. DOI: 10.1212/wnl.59.3.364.
[4]	于普林, 覃朝晖, 石婧, 等.北京市某城市社区老年人跌倒与慢性病关系的研究[J].中华流行病学杂志, 2009, 30(11): 1156-1159. DOI: 10.3760/cma.j.issn.0254-6450.2009.11.017. Yu PL, Yan ZH, Shi J, et al. Study on the relationship between falls and chronic diseases in a city community in Beijing[J]. Chin J Epidemiol, 2009, 30(11): 1156-1159. DOI: 10.3760/cma.j.issn.0254-6450.2009.11.017.
[5]	Cheng Y, Wu WY, Wang JQ, et al. Cinical research reliability and validity of the repeatable battery for the assessment of neuropsychological status in community-dwelling elderly[J]. Archives of Medical Science, 2011, 7(5): 850-857. DOI: 10.5114/aoms.2011.25561.
[6]	姜玉, 夏庆华, 胡嘉, 等.上海市长宁区老年人跌倒伤害流行病学及疾病负担研究[J].中华疾病控制杂志, 2013, 17(2): 134-137. http://www.cnki.com.cn/Article/CJFDTotal-JBKZ201302012.htm Jiang Y, Xia QH, Hu J, et al. Epidemiology and disease burden of fall injury in elderly people in Changning District, Shanghai[J]. Chin J Dis Control Prev, 2013, 17(2): 134-137. http://www.cnki.com.cn/Article/CJFDTotal-JBKZ201302012.htm
[7]	高茂龙, 宋岳涛.中国老年人跌倒发生率meta分析[J].北京医学, 2014, 36(10): 796-798. DOI: 10.15932/j.0253-9713.2014.10.051. Gao ML, Song YT. Meta-analysis of the incidence of falls in the elderly in China[J]. Beijing Medical Journal, 2014, 36(10): 796-798. DOI: 10.15932/j.0253-9713.2014.10.051.
[8]	纪妙音, 陈清聪, 李香玉.我国老年住院患者跌倒研究进展[J].中国老年保健医学, 2018, 16(4): 80-82. DOI: 10.3969/j.issn.1672-2671.2018.04.031. Ji MY, Chen QC, Li XY. Progress in the study of falls in elderly hospitalized patients in China[J]. Chinese Journal of Geriatrics and Health Care, 2018, 16(4): 80-82. DOI: 10.3969/j.issn.1672-2671.2018.04.031.
[9]	于卫华, 王莉, 徐忠梅.社区老年人常速行走步态特征与跌倒的相关性研究[J].中华护理杂志, 2017, 52(1): 44-48. DOI: 10.3761/j.issn.0254-1769.2017.01.009. Yu WH, Wang L, Xu ZM. Correlation between gait characteristics and falls in the elderly in community[J]. Chinese Journal of Nursing, 2017, 52(1): 44-48. DOI: 10.3761/j.issn.0254-1769.2017.01.009.
[10]	谢文丽, 张巨成.老年神经系统疾病患者跌倒原因分析[J].临床医药文献电子杂志, 2015, 2(18): 3635. DOI: 10.16281/j.cnki.jocml.2015.18.021. Xie WL, Zhang JC. Analysis of the causes of falls in elderly patients with neurological diseases[J]. Journal of Clinical Medicine and Literature, 2015, 2(18): 3635. DOI: 10.16281/j.cnki.jocml.2015.18.021.
[11]	刘青, 董文伟.中枢神经系统用药与老年人跌倒风险的相关性研究[J].实用药物与临床, 2015, 18(2): 235-237. DOI: 10.14053/j.cnki.ppcr.201502033. Liu Q, Dong WW. Correlation between central nervous system medication and risk of fall in the elderly[J]. Journal of Clinical Medicine and Clinics, 2015, 18(2): 235-237. DOI: 10.14053/j.cnki.ppcr.201502033.
[12]	Taylor ME, Delbaere K, Lord SR, et al. Physical impairments in cognitively impaired older people: implications for risk of falls[J]. Int Psychogeriatr, 2013, 25(1): 148-156. DOI: 10.1017/S1041610212001184.
[13]	Woollacott M, Shumway-Cook A. Attention and the control of posture and gait: a review of an emerging area of research[J]. Gait Posture, 2002, 16(1): 1-14. DOI: 10.1016/S0966-6362(01)00156-4.
[14]	王晨.北京市西城区社区老年人跌倒现况及危险因素调查[J].职业与健康, 2015, 31(1): 52-54. DOI: 10.13329/j.cnki.zyyjk.2015.0064. Wang C. Investigation on the current situation and risk factors of the fall of the elderly in Xicheng District, Beijing[J]. Occup and Health, 2015, 31(1): 52-54. DOI: 10.13329/j.cnki.zyyjk.2015.0064.
[15]	胡国萍, 眭万琼, 陈蜀萍.老年人跌倒的相关因素及其预防护理[J].护理学杂志, 2003, 18(5): 397-399. DOI: 10.3969/j.issn.1001-4152.2003.05.045. Hu GP, Yan WQ, Chen SP. Related factors of fall in the elderly and its preventive nursing[J]. Journal of Nursing Science, 2003, 18(5): 397-399. doi: 10.3969/j.issn.1001-4152.2003.05.045
[16]	冀艳虎, 李丽萍, 陈文涛.北京市社区老年人跌倒发生现况及危险因素分析[J].中华疾病控制杂志, 2012, 16(1): 22-24. http://www.cnki.com.cn/Article/CJFDTotal-JBKZ201201010.htm Ji YH, Li LP, Chen WT. Analysis of the current situation and risk factors of falls in the elderly in Beijing community[J]. Chin J Dis Control Prev, 2012, 16(1): 22-24. http://www.cnki.com.cn/Article/CJFDTotal-JBKZ201201010.htm
[17]	徐大麟, 孙伯燕, 王萍玉. 1986-2003年上海市静安区老年人意外死亡的特点和趋势[J].中华老年医学杂志, 2004, 23(11): 820-822. http://www.cqvip.com/QK/95748X/200411/11091702.html Xu DL, Sun BY, Wang PY. Characteristics and trends of accidental death in the elderly in Jing'an District of Shanghai from 1986 to 2003[J]. Chinese Journal of Geriatrics, 2004, 23(11): 820-822. http://www.cqvip.com/QK/95748X/200411/11091702.html
[18]	周顺福, 宋桂香, 李延红, 等.老年妇女跌倒性伤害的预防与控制[J].上海预防医学杂志, 2005, 17(3): 113-115. DOI: 10.19428/j.cnki.sjpm.2005.03.005. Zhou SF, Song GX, Li YH, et al. Prevention and control of fall injury in elderly women[J]. Shanghai J Prev Med, 2005, 17(3): 113-115. DOI: 10.19428/j.cnki.sjpm.2005.03.005.
[19]	Hacihasanoǧlu R, Yildirim A, Karakurt P.Loneliness in elderly individuals, level of dependence in activities of daily living (ADL) and influential factors[J].Arch Gerontol Geriatr, 2012, 54(1):61-66.DOI: 10.1016/j.archger.2011.03.011
[20]	黄丽洁.社区老年人运动功能、跌倒效能与生活质量的关系研究[D].锦州: 锦州医科大学, 2018. Huang LJ. Relationship between sports function, fall performance and quality of life in the elderly[D]. Jin Zhou: Jinzhou Medical University, 2018.