活动能力测试对社区老年人跌倒风险的预测价值

Physical function tests for predicting falls among community-dwelling older adults

目的研究一个预测模型，用于社区居家老年人跌倒筛查，并量化活动能力与跌倒的关系。方法随机选取北京四个社区65岁以上老年人144例，根据过去1年是否跌倒分为跌倒组和非跌倒组，其中跌倒组50例，非跌倒组94例。对两组受试者进行功能性步态测试（FGA）、Berg平衡量表（BBS）评定、功能性伸展测试（FRT）、感觉整合和平衡的临床改良测试（CISIB）、单腿站立（OLS）、记时起立行走实验（TUGT）、10米步行时间，功能性伸展实验。跌倒组和非跌倒组之间各项测试的差异进行分析，除了睁眼、闭眼平地站立和睁眼抬头平地站立外，其余均具有统计学差异，并对其进行logistic回归分析。结果2组受试者除睁眼平地站立、闭眼平地站立和睁眼抬头平地站立外，其余各项测试组间比较，差异均有统计学意义（P〈0．05）。Logistic模型结果显示，FGA总分和mCISIB中的睁眼站立海绵垫上对跌倒的预测最有意义，其中敏度性为80％，特异度为74．2％。FGA和睁眼站立海绵垫上的敏感度和特异度分别为76％，74．2％和56％，81．6％。模型的受试者工作特征曲线（ROC曲线）下面积为0．845。结论该模型可用于社区居家健康老年人跌倒的筛查，预测社区老年人跌倒的敏感性优于FGA和睁眼站立海绵垫上，特异性与FGA相似。量化社区居家老年人活动能力与跌倒的关系，为跌倒预防提供数据。

Objective To establish a model predicting the fall risk of healthy, community-dwelling elderly persons and to quantify the relationship between physical function and fall risk. Methods One hundred and fortyfour healthy subjects aged ≥65 years and living independently were recruited. Fifty were classified as fallers and 94 as non-railers according to their history of falling during the previous year. Functional gait assessment （FGA） , the Berg balance scale （BBS） , a functional reach test （FRT） , a modified clinical test of sensory integration for balance （CISIB） , one-leg stance, the timed up and go test （TUGT） and the 10 meter walk test were used to distinguish the fallers from the non-fallers, and the significant variables were subjected to logistic regression analysis. Results Each of the tests generated significant differences between non-fallers and fallers except for standing in place with the eyes open and closed. Logistic regression showed that total FGA scores and the results of standing on a foam surface with the eyes open （FOEO） significantly predicted faller status with 80% sensitivity and 74. 2% specificity. Conclusions This model can be used to predict fall risk for healthy, community-dwelfing elderly persons. It is more sensitive than the FGA and FOEO and similarly specific.