中国老年人不同严重程度跌倒风险与慢性病和睡眠的关联研究

林进龙; 魏玥; 陈功; 裴丽君

doi:10.16462/j.cnki.zhjbkz.2021.01.006

中国老年人不同严重程度跌倒风险与慢性病和睡眠的关联研究

doi: 10.16462/j.cnki.zhjbkz.2021.01.006

100871 北京，北京大学人口研究所，北京大学人口与健康发展研究中心

基金项目:

国家自然科学基金 41871360

国家重点研发计划 2018YFC2000603

详细信息

通讯作者:
裴丽君，E-mail: peilj@pku.edu.cn

中图分类号: R181
计量
- 文章访问数: 576
- HTML全文浏览量: 317
- PDF下载量: 141
- 被引次数: 0
出版历程
- 收稿日期: 2020-06-16
- 修回日期: 2020-10-19
- 刊出日期: 2021-01-10

Chronic diseases and sleep duration in association with falls of different severity among the Chinese elderly

Institute of Population Research, China Center on Population Health and Development, Peking University, Beijing 100871, China

Funds:

National Natural Science Fund 41871360

National Key Research and Development Project 2018YFC2000603

More Information

Corresponding author: PEI Li-jun, E-mail: peilj@pku.Edu.cn

摘要

摘要: 目的探索老年人慢性疾病和睡眠状况与不同严重程度跌倒风险之间的关联，为老年人跌倒所致伤害的预防和干预提供线索。方法采用病例对照研究发生风险，以“中国健康与养老追踪调查项目”数据为基础，利用2011-2015年抽样调查数据，运用多因素Logistic回归分析模型分析慢性疾病和睡眠的暴露与中国老年人普通跌倒和跌倒就医发生风险的关联。结果 11 912例老年人两年内普通跌倒报告率和跌倒就医报告率分别为7.82%和17.09%;多因素Logistic回归分析模型结果显示，听力退化、身体疼痛、有抑郁症状、肾脏病、关节炎和日常生活自理能力(activities of daily living, ADL)受损与老年人普通跌倒和跌倒就医发生风险存在关联(均有P < 0.05);患高血糖与普通跌倒发生风险存在关联(OR=1.43, 95% CI: 1.13~1.81, P=0.002)，患脑卒中与跌倒就医发生风险存在关联(OR=1.34, 95% CI: 1.03~1.75, P=0.031);睡眠时长5~ h和≥7 h与老年人两类跌倒发生风险存在负关联(均有P < 0.05)。结论老年人退行性疾病及慢性疾病可能是跌倒发生的共同危险因素，充足的睡眠可能是两类跌倒的共同保护因素，应当针对高危老年人群体和暴露因素开展跌倒的预防和干预。
- 老年人 /
- 跌倒 /
- 严重程度 /
- 危险因素
Abstract: Objective To explore the relationship between chronic diseases, sleeping time and the risk of falls of different severity in the elderly, so as to provide effective prevention of falls scientifically. Methods Based on the data of China Health and Retirement Longitudinal Study (CHARLS) from 2011 to 2015, a case-control study was conducted to analyze the relationship between multiple exposure factors and the risk of falls in different severity in the elderly. Results The report rate of common falls and serious falls medical in 11 912 elderly Chinese within two years were 7.82% and 17.09%, respectively; logistic regression results show that, hearing impairment, body pain, depression, kidney disease, arthritis and disability were the same risk factors of common falls and serious falls in the elderly(all P < 0.05). Hyperglycemia was associated with the risk of common falls (OR=1.43, 95% CI: 1.13-1.81, P=0.002) and stroke (OR=1.34, 95% CI: 1.03-1.75, P=0.031) was associated with the risk of serious falls; sleep duration of 5- hours and ≥ 7 hours were negatively associated with the risk of two types of falls (all P < 0.05). Conclusions The common falls and serious falls have multiple same risk factors in the elderly, and adequate sleep is the common protective factor for both. It is suggested that fall prevention education should be carried out for the elderly and risk factors should be effectively intervened.
- Elderly /
- Fall /
- Severity /
- Risk factors

HTML全文

表 1 老年人两年内跌倒伤害报告率[n(%)]

Table 1. The report rate of fall among elderly people in two years [n(%)]

特征	调查(例)	普通跌倒(例)	跌倒就医(例)	普通跌倒报告率 (95% CI)值	跌倒就医报告率 (95% CI)值	跌倒报告率 (95% CI)值
总人群	11 912	932	2 036	7.82(7.34~8.31)	17.09(16.42~17.77)	24.92(24.14~25.69)
性别^a
男	5 922(49.73)	411(44.10)	772(37.92)	6.94(6.29~7.59)	13.04(12.18~13.89)	19.98(18.96~20.99)
女	5 987(50.27)	521(55.90)	1 264(62.08)	8.70(7.99~9.42)	20.08(18.15~22.17)	29.81(28.66~30.97)
年龄(岁)
60~	8 312(69.78)	624(66.95)	1 202(59.04)	7.51(6.94~8.08)	14.46(13.71~15.22)	21.97(21.08~22.87)
70~	2 778(23.32)	243(26.07)	606(29.76)	8.75(7.70~9.80)	21.82(13.71~15.22)	30.56(28.85~32.27)
≥80	822(6.90)	65(26.14)	228(11.20)	7.91(6.06~9.75)	27.74(24.68~30.80)	35.64(32.37~38.92)
注：^a性别：性别变量剔除3例缺失值信息; 表格显示的跌倒伤害报告率为2011、2013和2015年三次调查数据的计算结果; 性别、年龄在普通跌倒和跌倒就医病例与对照之间差异均有统计意义(均有P < 0.05)。

下载: 导出CSV

表 2 老年人不同严重程度跌倒的病例对照暴露因素[n(%)]

Table 2. Exposure factors for falls of different severity in the elderly between case and control [n(%)]

特征	对照组(n=8 018)	普通跌倒(n=803)			跌倒就医(n=1 782)
特征	对照组(n=8 018)	例数	χ²值	P值	例数	χ²值	P值
年龄(岁)			8.289	0.016		104.355	< 0.001
60~	5 894(73.51)	554(68.99)			1 101(61.78)
70~	1 704(21.25)	205(25.53)			519(29.12)
≥80	420(5.24)	44(5.48)			162(9.09)
性别			23.359	< 0.001		133.132	< 0.001
男	4 271(53.27)	356(44.33)			680(38.16)
女	3 747(46.73)	447(55.67)			1 102(61.84)
教育程度				0.004		66.660	< 0.001
文盲	2 618(32.65)	309(38.48)	11.250		715(40.12)
小学	3 444(42.95)	318(39.60)			778(43.66)
初中及以上	1 956(24.40)	176(21.92)			289(16.22)
吸烟			5.174	0.075		68.952	< 0.001
从未吸烟	4 455(55.56)	475(59.15)			1 154(64.76)
过去吸烟	1 270(15.84)	106(13.20)			285(15.99)
现在吸烟	2 293(28.60)	222(27.65)			343(19.25)
饮酒			0.568	0.451		9.574	0.002
不饮酒	5 407(67.44)	531(66.13)			1 269(71.21)
饮酒	2 611(32.56)	272(33.87)			513(28.79)
睡眠时长(h)			52.717	< 0.001		128.598	< 0.001
< 5	1 479(18.45)	230(28.64)			536(30.08)
5~	2 812(35.07)	273(34.00)			592(33.22)
≥7	3 727(46.48)	300(37.36)			654(36.70)
午休时长(min)			1.820	0.402		25.894	< 0.001
无午休	3 537(44.11)	350(43.59)			894(50.17)
< 30	1 227(15.30)	111(13.82)			212(11.90)
≥30	3 254(40.58)	342(42.59)			676(37.93)
听力			58.561	< 0.001		84.352	< 0.001
好	3 203(39.95)	210(26.15)			504(28.28)
不好	4 815(60.05)	593(73.85)			1 278(71.72)
近视力			19.673	< 0.001		33.575	< 0.001
好	2 621(32.69)	201(25.03)			457(25.65)
不好	5 397(67.31)	602(74.97)			1 325(74.35)
远视力			36.483	< 0.001		82.255	< 0.001
好	2 709(33.79)	187(23.29)			405(22.73)
不好	5 309(66.21)	616(76.71)			1 377(77.27)
身体疼痛			69.664	< 0.001		148.691	< 0.001
无	6 257(78.04)	522(65.01)			1 146(64.31)
有	1 761(21.96)	281(34.99)			636(35.69)
抑郁症状			65.493	< 0.001		214.770	< 0.001
无	5 509(68.71)	439(54.67)			899(50.45)
有	2 509(31.29)	364(45.33)			883(49.55)
高血糖			17.200	< 0.001		11.159	< 0.001
无	7 396(92.24)	707(88.04)			1 601(89.84)
有	662(7.76)	96(11.96)			181(10.16)
脑卒中			4.674	0.031		25.772	< 0.001
无	7 796(97.23)	770(95.89)			1 691(94.89)
有	222(2.77)	33(4.11)			91(5.11)
肾脏病			18.633	< 0.001		45.937	< 0.001
无	7 556(94.24)	726(90.41)			1 601(89.84)
有	462(5.76)	77(9.59)			181(10.16)
关节炎			62.288	< 0.001		154.156	< 0.001
无	5 384(67.15)	428(53.30)			919(51.57)
有	2 634(32.85)	375(46.70)			863(48.43)
ADL			99.927	< 0.001		324.843	< 0.001
自理	7 082(88.33)	610(75.97)			1 276(71.60)
失能	936(11.67)	193(24.03)			506(28.40)

下载: 导出CSV

表 3 老年人不同严重程度跌倒的暴露因素多因素分析

Table 3. Multivariate analysis of exposure factors for falls of different severity in the elderly

特征	普通跌倒^a			跌倒就医^b
特征	OR(95% CI)值	Wald χ²值	P值	OR(95% CI)值	Wald χ²值	P值
睡眠时长(h)
＜5	1.00			1.00
5~	0.79(0.65~0.97)	5.378	0.020	0.83(0.72~0.96)	6.194	0.012
≥7	0.71(0.58~0.86)	12.184	< 0.001	0.74(0.64~0.85)	16.898	< 0.001
午休时长(min)
无午休	-	-	-	1.00
< 30	-	-	-	0.67(0.57~0.80)	19.621	< 0.001
≥30	-	-	-	0.92(0.82~1.03)	1.963	0.161
听力
好	1.00			1.00
不好	1.52(1.27~1.82)	21.047	< 0.001	1.28(1.13~1.45)	14.700	< 0.001
近视力
好	1.00			1.00
不好	1.03(0.85~1.24)	0.074	0.785	0.97(0.85~1.11)	0.160	0.688
远视力
好	1.00			1.00
不好	1.14(0.94~1.39)	1.674	0.196	1.17(1.01~1.35)	4.696	0.030
身体疼痛
无	1.00			1.00
有	1.26(1.06~1.50)	6.822	0.009	1.21(1.07~1.37)	8.808	0.003
抑郁症状
无	1.00			1.00
有	1.23(1.05~1.45)	6.330	0.011	1.41(1.26~1.60)	33.052	< 0.001
高血糖
无	1.00			1.00
有	1.43(1.13~1.81)	8.855	0.002	1.18(0.99~1.43)	3.281	0.070
脑卒中
无	1.00			1.00
有	1.09(0.74~1.61)	0.203	0.652	1.34(1.03~1.75)	4.624	0.031
肾脏病
无	1.00			1.00
有	1.33(1.02~1.74)	4.558	0.032	1.50(1.24~1.82)	16.920	< 0.001
关节炎
无	1.00			1.00
有	1.39(1.19~1.63)	17.309	< 0.001	1.42(1.27~1.59)	36.956	< 0.001
ADL
自理	1.00			1.00
失能	1.63(1.34~1.99)	23.653	< 0.001	1.88(1.63~2.16)	77.094	< 0.001
注：^a普通跌倒：普通跌倒的多因素Logistic回归分析模型：调整了年龄、性别、教育程度。其中，午休时长变量在单因素检验中差异无统计学意义且尚无明确证据表明午休对普通跌倒存在重要影响，故不纳入模型; ^b跌倒就医跌倒就医的多因素Logistic回归分析模型：调整了年龄、性别、教育程度、吸烟、饮酒。

下载: 导出CSV

参考文献(41)

[1]	World Health Organization. Falls[EB/OL]. (2018-01-16)[2020-03-30]. https://www.who.int/news-room/fact-sheets/detail/falls.
[2]	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 fall incidence in the elderly in China[J]. Beijing Med J, 2014, 36(10):796-798. DOI: 10.15932/j.0253-9713.2014.10.051.
[3]	中国老年保健医学研究会老龄健康服务与标准化分会.中国老年人跌倒风险评估专家共识(草案)[J].中国老年保健医学, 2019, 17(4):47-48, 50. DOI: 10.3969/j.issn.1672-2671.2019.04.013. Aging health service and standardization branch of China geriatric health care Medical Research Association. Expert consensus on fall risk assessment for the elderly in China (Draft)[J]. Chin J Geriatr Care, 2019, 17(4):47-48, 50. DOI: 10.3969/j.issn.1672-2671.2019.04.013.
[4]	World Health Organization. WHO Global Report on Falls Prevention in Older Age[EB/OL]. (2018-03-07)[2020-03-30]. http://www.who.int/ageing/publications/Falls_prevention7March.pdf.
[5]	Deandrea S, Lucenteforte E, Bravi F, et al. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis[J]. Epidemiology, 2010, 21(5):658-668. DOI: 10.1097/EDE.0b013e3181e89905.
[6]	Bergland A, Wyller TB. Risk factors for serious fall related injury in elderly women living at home[J]. Injury Prevention, 2004, 10(5):308-313. DOI: 10.1136/ip.2003.004721.
[7]	Dionyssiotis Y. Analyzing the problem of falls among older people[J]. Int J Gen Med, 2012, 5:805-813. DOI: 10.2147/IJGM.S32651.
[8]	袁敬国, 林凯, 李衡, 等.深圳市盐田区2017年跌倒/坠落伤害病例特征与空间聚集性[J].中华疾病控制杂志, 2019, 23(6):733-736. DOI: 10.16462/j.cnki.zhjbkz.2019.06.022. Yuan JG, Lin K, Li H, et al. Characteristics and spatial clusters analysis of falls in Yantian Distric of Shenzhen City, 2017[J]. Chin J Dis Prev, 2019, 23(6):733-736. DOI: 10.16462/j.cnki.zhjbkz.2019.06.022.
[9]	林伟权, 刘慧, 利耀辉, 等. 2014-2018年广州市60岁及以上老年人跌倒/坠落伤害流行病学特征[J].中华疾病控制杂志, 2020, 24(3):269-273. DOI: 10.16462/j.cnki.zhjbkz.2020.03.005. Lin WQ, Liu H, Li YH, et al. Epidemiological characteristics of injury caused by fall in the elderly aged ≥60 years in Guangzhou in 2014-2018[J]. Chin J Dis Prev, 2020, 24(3):269-273. DOI: 10.16462/j.cnki.zhjbkz.2020.03.005.
[10]	Morin L, Calderon Larrañaga A, Welmer AK, et al. Polypharmacy and injurious falls in older adults: a nationwide nested case-control study[J]. Clin Epidemiol, 2019, 11(3):483-493. DOI: 10.2147/CLEP.S201614.
[11]	Gill TM, Pahor M, Guralnik JM, et al. Effect of structured physical activity on prevention of serious fall injuries in adults aged 70-89: randomized clinical trial(LIFE Study)[J]. BMJ, 2016, 352:i245. DOI: 10.1136/bmj.i245.
[12]	Alqahtani BA, Alshehri MM, Hoover JC, et al. Prevalence of falls among older adults in the Gulf Cooperation Council countries: a systematic review and meta-analysis[J]. Archives of Gerontology and Geriatrics, 2019, 83:169-174. DOI: 10.1016/j.archger.2019.04.006.
[13]	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, Qin CH, Shi J, et al. Study on the relationship between chronic diseases and falls in the elderly[J]. Chin J Epidemiol, 2009, 30(11):1156-1159. DOI: 10.3760/cma.j.issn.0254-6450.2009.11.017.
[14]	Paliwal Y, Slattum PW, Ratliff SM. Chronic health conditions as a risk factor for falls among the community-dwelling US older adults: a zero-inflated regression modeling approach[J]. Biomed Res Int, 2017:5146378. DOI: 10.1155/2017/5146378.
[15]	Sibley KM, Voth J, Munce SE, et al. Chronic disease and falls in community-dwelling canadians over 65 years old: a population-based study exploring associations with number and pattern of chronic conditions[J]. BMC Geriatr, 2014, 14(22). DOI: 10.1136/bmj.i245.
[16]	Essien SK, Feng CX, Sun W, et al. Sleep duration and sleep disturbances in association with falls among the middle-aged and older adults in China: a population-based nationwide study[J]. BMC Geriatr, 2018, 18(1):196. DOI: 10.1186/s12877-018-0889-x.
[17]	Mesas AE, López E, Rodríguez F. Self-reported sleep duration and falls in older adults[J]. J Sleep Res, 2011, 20(1 Pt 1):21-27. DOI: 10.1111/j.1365-2869.2010.00867.x
[18]	Zhao Y, Hu Y, Smith JP, et al. Cohort profile: the China Health and Retirement Longitudinal Study (CHARLS)[J]. Int J Epidemiol, 2014, 43(1):61-68. DOI: 10.1093/ije/dys203.
[19]	刘素, 严亚琼, 李芳, 等. 2018年武汉市老年人跌倒伤害及其影响因素[J].中华疾病控制杂志, 2020, 24(4):480-484. DOI: 10.16462/j.cnki.zhjbkz.2020.04.021. Liu S, Yan YQ, LI F, et al. Epidemiologic characteristics of fall related-injuries and related factors among elderly population in Wuhan, 2018[J]. Chin J Dis Prev, 2020, 24(4):480-484. DOI: 10.16462/j.cnki.zhjbkz.2020.04.021.
[20]	Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activity of daily living[J]. Gerontologist, 1988, 13(1):64-68. DOI: 10.1007/BF01041502.
[21]	Boey KW. Cross-validation of a short form of the CES-D in Chinese elderly[J]. Int J Geriatr Psychiatry, 1999, 14(8):608-617. DOI:10.1002/(sici)1099-1166(199908)14:8 < 608::aid-gps991>3.0.co; 2-z.
[22]	Andresen EM, Malmgren JA, Carter WB, et al. Screening for depression in well older adults: evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale)[J]. Am J Prev Med, 1994, 10(2):77-84. DOI: 10.1002/ajim.4700250315.
[23]	Kempton A, Van Beurden E, Sladden T, et al. Older people can stay on their feet: final results of acommunity-based falls prevention program[J]. Health Promot Intern, 2000, 15:27-33. DOI: 10.1093/heapro/15.1.27.
[24]	Jack CI, Smith T, Neoh C, et al. Prevalence of low vision in elderly patients admitted to an acute geriatric unit in Liverpool: elderly people who fall are more likely to have low vision[J]. Gerontology, 1995, 41(5):280-285. DOI: 10.1159/000213695.
[25]	Wierenga PC, Buurman BM, Parlevliet JL, et al. Association between acute geriatric syndromes and medication-related hospital admissions[J]. Drugs Aging, 2012, 29(8):691-699. DOI: 10.1007/BF03262284.
[26]	Javier D, Pastor BR, Valderrama GE, et al. Factors associated with falls among older adults living in institutions[J]. Bmc Geriatrics, 2013, 13(1):6. DOI: 10.1186/1471-2318-13-6.
[27]	Hallert E, Husberg M, Kalkan A, et al. Early rheumatoid arthritis 6 years after diagnosis is still associated with high direct costs and increasing loss of productivity: the Swedish TIRA project[J]. Scand J Rheumatol, 2014, 43(3):177-183. DOI: 10.3109/03009742.2013.835442.
[28]	Shimada H, Suzukawa M, Ishizaki T, et al. Relationship between subjective fall risk assessment and falls and fall-related fractures in frail elderly people[J]. BMC Geriatr, 2011, 8(11):40. DOI: 10.1186/1471-2318-11-40.
[29]	Manlapaz DG, Sole G, Jayakaran P, et al. Risk factors for falls in adults with knee osteoarthritis: a systematic review[J]. PM R, 2019, 11:745-757. DOI: 10.1002/pmrj.12066.
[30]	Yabe Y, Hagiwara Y, Sekiguchi T, et al. Musculoskeletal pain and new-onset poor physical function in elderly survivors of a natural disaster: a longitudinal study after the great East Japan earthquake[J]. BMC Geriatr, 2019, 19:274. DOI: 10.1186/s12877-019-1283-z.
[31]	Rasheeda KH, Lawrence RL, Ann M, et al. Chronic kidney disease and recurrent falls in nursing home residents: a retrospective cohort study[J]. Geriatric Nursing, 2015, 36(2):136-141. DOI: 10.1016/j.gerinurse.2014.12.012.
[32]	Goto NA, Hamaker ME, Willems HC, et al. Accidental falling in community-dwelling elderly with chronic kidney disease[J]. Int Urol Nephrol, 2019, 51:119-127. DOI: 10.1007/s11255-018-1992-9.
[33]	Wang YJ, Zhang SM, Zhang L, et al. Chinese guidelines for the secondary prevention of ischemic stroke and transient ischemic attack[J]. CNS Neurosci Ther, 2012, 18(2):93-101. DOI: 10.1111/j.1755-5949.2011.00290.x.
[34]	Kerse N, Parag V, Feigin VL, et al. Falls after stroke: results from the Auckland regional community stroke (ARCOS) study, 2002 to 2003[J]. J Am Heart Assoc, 2008, 39(6):1890-1893. DOI: 10.1161/strokeaha.107.509885.
[35]	Pinto EB, Nascimento C, Marinho C, et al. Risk factors associated with falls in adult patients after stroke living in the community: baseline data from a stroke cohort in Brazil[J]. Top Stroke Rehabil, 2014, 21(3):220-227. DOI: 10.1310/tsr2103-220.
[36]	Stone KL, Blackwell TL, Ancoli IS, et al. Sleep disturbances and risk of falls in older community-dwelling men: the outcomes of sleep disorders in older men (MROS sleep) study[J]. J Am Geriatr Soc, 2014, 62(2):299-305. DOI: 10.1111/jgs.12649.
[37]	Takada S, Yamamoto Y, Shimizu S, et al. Association between subjective sleep quality and future risk of falls in older people: results from LOHAS[J]. J Gerontol A Biol Sci Med Sci, 2017, 73(9):1205-1211. DOI: 10.1093/gerona/glx123.
[38]	Abbott SM, Videnovic A. Chronic sleep disturbance and neural injury: links to neurodegenerative disease[J]. Nat Sci Sleep, 2016, 8(1):55-61. DOI: 10.2147/NSS.S78947.
[39]	Chen TY, Lee S, Buxton OM. A greater extent of insomnia symptoms and physician-recommended sleep medication usepredict fall risk in community-dwelling older adults[J]. Sleep, 2017, 40 (11):zsx142. DOI: 10.1093/sleep/zsx142.
[40]	Brassington GS, King AC, Bliwise DL. Sleep problems as a risk factor for falls in a sample of community-dwelling adults aged 64-99 years[J]. J Am Geriatr Soc, 2000, 48(10):1234-1240. DOI: 10.1111/j.1532-5415.2000.tb02596.x.
[41]	Ancoli IS. Sleep and aging: prevalence of disturbed sleep and treatment considerations in older adults[J]. J Clin Psychiatry, 2005, 66(9):24-30. DOI: 10.1038/432449a.