老年人时间-空间步态特征和不良健康结局风险

Spatio-temporal gait characteristics of the elderly and the risk of adverse health outcomes

背景:步态是衡量老年人功能状态的最佳指标之一。步态参数与老年人不良健康结局相关。目的:总结比较步态参数之间的实际应用价值,对老年人时间-空间参数与不良健康结局风险的研究进展进行综述。方法:以“gait speed,walking speed,step length,cadence,step frequency,step time,walking base,aged and elderly”为英文检索词,以“步速,步长,步频,步行时间,步宽,老年人”为中文检索词,检索PubMed、Web of Science、中国知网数据库2010年1月至2023年6月发表的相关文献,最终纳入52篇文献进行综述分析。结果与结论:(1)目前研究者多关注“步速、步长、步频”3项基础时间-空间参数,探索其与老年人不良健康结局的关联。(2)老年人步速降低可能会增加跌倒、全因死亡的风险,或是全因死亡的独立预测因子;慢步速老年人出现认知功能下降的风险更高,在评估老年人认知障碍时步速或许能作为首选的步态参数;慢步速老年人患衰弱或常见慢性疾病的比例更高,且有着更高住院和公共照料的风险。(3)步长与个体身高和下肢长度呈正相关,但年龄增长引起的步长缩短与身高和下肢长度无关,步长缩短反映出老年人身体功能的降低,步长缩短是老年人跌倒事件发生、认知功能下降的风险因素。(4)步频常作为衡量运动强度的指标,步频≥100步/min能够预测全因死亡率,步频减慢可能会导致老年人有更高的跌倒、住院和全因死亡风险。(5)步态参数的变化和老年人身体健康水平密切相关,并且两者可能存在双向关系。研究结果将为进一步提升临床人群风险筛查、完善老年人健康风险评估、提高老年人健康保障和促进主动健康提供理论依据。

BACKGROUND:Gait is one of the optimal indicators of functional status in older adults.Gait parameters are associated with adverse health outcomes in older adults.OBJECTIVE:To summarize and compare the practical value of gait parameters,and to review the progress of research on spatio-temporal parameters and the risk of adverse health outcomes in older adults.METHODS:PubMed,Web of Science,and CNKI were searched for relevant literature published from January 2010 to June 2023 using the search terms of“gait speed,walking speed,step length,cadence,step frequency,step time,walking base,aged and elderly”in English and Chinese,respectively.A total of 52 papers were finally included for the systematic review.RESULTS AND CONCLUSION:Currently,researchers have focused on three basic temporal-spatial parameters,namely,step speed,step length and step frequency,to explore their association with adverse health outcomes in older adults.Reduced gait speed in older adults may increase the risk of falls,all-cause mortality,and may be an independent predictor of all-cause mortality.Older adults with slow gait speed are at higher risk of cognitive decline,and may be the preferred gait parameter in assessing cognitive impairment in older adults.Older adults with slow gait speed are more likely to have debilitating or common chronic illnesses,and are at higher risk of hospitalization and public care.Step length is positively correlated with individual height and lower limb length,but age-induced shortening of step length is not related to height or lower limb length,and shortening of step length reflects reduced physical function in older adults,and shortening of step length is a risk factor for falls and cognitive decline in older adults.Stride frequency is often used as a measure of exercise intensity,and a stride frequency of≥100 steps/minute is predictive of all-cause mortality,and slowing of step frequency may lead to a higher risk of falls,hospitalization and all-cause mortality in older adults.Changes in gait parameters are closely related to the level of physical fitness in older adults,and there may be a bidirectional relationship between the two.The results of the study will provide a theoretical basis for further improving risk screening in clinical populations,refining health risk assessment in the elderly,improving health protection and promoting active health in the elderly.