Manuel Montero-Odasso, Frederico Pieruccini-Faria, Surim Son, Daniela Cristina Carvalho de Abreu, Susan Hunter, Jia Qi Liu, Marissa Moore, Areej Hezam, Nathalie van der Velde, Tahir Masud, Jesper Ryg, Mirko Petrovic, Mark Speechley
{"title":"老年人跌倒风险分层：低风险和无风险状态仍与跌倒和损伤有关。","authors":"Manuel Montero-Odasso, Frederico Pieruccini-Faria, Surim Son, Daniela Cristina Carvalho de Abreu, Susan Hunter, Jia Qi Liu, Marissa Moore, Areej Hezam, Nathalie van der Velde, Tahir Masud, Jesper Ryg, Mirko Petrovic, Mark Speechley","doi":"10.1093/ageing/afaf064","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Falls guidelines recommendations for individuals classified as 'not-at-risk' range from no further actions to offering education and exercises. However, there is a scarcity of prospective studies analysing the rate of falls and injuries in this not-at-risk group to inform recommendations.</p><p><strong>Objective: </strong>To prospectively estimate the rate of falls and injuries in older adults considered 'not-at-risk' for falls.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Geriatric Medicine Clinics.</p><p><strong>Subjects: </strong>Community-dwelling older adults aged 65 and older.</p><p><strong>Methods: </strong>Falls risk stratification was operationalised by adapting the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths and Injuries algorithm. Associations of risk strata (screened not-at-risk vs. at-risk) with incident falls and injuries were estimated using incidence rate ratios [adjusted incident rate ratio (aIRR), Poisson regression model]. Associations between slow gait speed (<1 m/s) and injurious falls were estimated by risk strata using hazard ratios (adjusted hazard ratio, Cox and Poisson regression model).</p><p><strong>Results: </strong>Of 403 participants, 64% of at-risk individuals fell during the follow-up compared to 41.3% in the not-at-risk group, whilst injurious falls were reported by 63.2% of the not-at-risk group and by 59.7% of the at-risk group. At-risk individuals had a higher rate of falls (aIRR = 3.91, 95% CI: 3.30-4.64, P < .001) but a similar rate of injurious falls as the not-at-risk individuals (aIRR = 1.26, 95% CI: 0.93-1.71; P = .11). Not-at-risk individuals with slow gait speed sustained injurious falls at twice the rate (aIRR = 1.83, 95% CI: 1.12-3.91, P = .008) than those without slow gait speed.</p><p><strong>Conclusions: </strong>Being screened as not-at-risk for falls does not mean no risk at all. Routinely and universally assessing gait speed could identify not-at-risk individuals who are likely to sustain injuries after a fall and could benefit from primary prevention.</p>","PeriodicalId":7682,"journal":{"name":"Age and ageing","volume":"54 3","pages":""},"PeriodicalIF":6.0000,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942794/pdf/","citationCount":"0","resultStr":"{\"title\":\"Fall risk stratification in older adults: low and not-at-risk status still associated with falls and injuries.\",\"authors\":\"Manuel Montero-Odasso, Frederico Pieruccini-Faria, Surim Son, Daniela Cristina Carvalho de Abreu, Susan Hunter, Jia Qi Liu, Marissa Moore, Areej Hezam, Nathalie van der Velde, Tahir Masud, Jesper Ryg, Mirko Petrovic, Mark Speechley\",\"doi\":\"10.1093/ageing/afaf064\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Falls guidelines recommendations for individuals classified as 'not-at-risk' range from no further actions to offering education and exercises. However, there is a scarcity of prospective studies analysing the rate of falls and injuries in this not-at-risk group to inform recommendations.</p><p><strong>Objective: </strong>To prospectively estimate the rate of falls and injuries in older adults considered 'not-at-risk' for falls.</p><p><strong>Design: </strong>Prospective cohort study.</p><p><strong>Setting: </strong>Geriatric Medicine Clinics.</p><p><strong>Subjects: </strong>Community-dwelling older adults aged 65 and older.</p><p><strong>Methods: </strong>Falls risk stratification was operationalised by adapting the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths and Injuries algorithm. Associations of risk strata (screened not-at-risk vs. at-risk) with incident falls and injuries were estimated using incidence rate ratios [adjusted incident rate ratio (aIRR), Poisson regression model]. Associations between slow gait speed (<1 m/s) and injurious falls were estimated by risk strata using hazard ratios (adjusted hazard ratio, Cox and Poisson regression model).</p><p><strong>Results: </strong>Of 403 participants, 64% of at-risk individuals fell during the follow-up compared to 41.3% in the not-at-risk group, whilst injurious falls were reported by 63.2% of the not-at-risk group and by 59.7% of the at-risk group. At-risk individuals had a higher rate of falls (aIRR = 3.91, 95% CI: 3.30-4.64, P < .001) but a similar rate of injurious falls as the not-at-risk individuals (aIRR = 1.26, 95% CI: 0.93-1.71; P = .11). Not-at-risk individuals with slow gait speed sustained injurious falls at twice the rate (aIRR = 1.83, 95% CI: 1.12-3.91, P = .008) than those without slow gait speed.</p><p><strong>Conclusions: </strong>Being screened as not-at-risk for falls does not mean no risk at all. Routinely and universally assessing gait speed could identify not-at-risk individuals who are likely to sustain injuries after a fall and could benefit from primary prevention.</p>\",\"PeriodicalId\":7682,\"journal\":{\"name\":\"Age and ageing\",\"volume\":\"54 3\",\"pages\":\"\"},\"PeriodicalIF\":6.0000,\"publicationDate\":\"2025-03-03\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11942794/pdf/\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Age and ageing\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ageing/afaf064\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"GERIATRICS & GERONTOLOGY\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Age and ageing","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ageing/afaf064","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"GERIATRICS & GERONTOLOGY","Score":null,"Total":0}
Fall risk stratification in older adults: low and not-at-risk status still associated with falls and injuries.
Background: Falls guidelines recommendations for individuals classified as 'not-at-risk' range from no further actions to offering education and exercises. However, there is a scarcity of prospective studies analysing the rate of falls and injuries in this not-at-risk group to inform recommendations.
Objective: To prospectively estimate the rate of falls and injuries in older adults considered 'not-at-risk' for falls.
Design: Prospective cohort study.
Setting: Geriatric Medicine Clinics.
Subjects: Community-dwelling older adults aged 65 and older.
Methods: Falls risk stratification was operationalised by adapting the Centers for Disease Control and Prevention's Stopping Elderly Accidents, Deaths and Injuries algorithm. Associations of risk strata (screened not-at-risk vs. at-risk) with incident falls and injuries were estimated using incidence rate ratios [adjusted incident rate ratio (aIRR), Poisson regression model]. Associations between slow gait speed (<1 m/s) and injurious falls were estimated by risk strata using hazard ratios (adjusted hazard ratio, Cox and Poisson regression model).
Results: Of 403 participants, 64% of at-risk individuals fell during the follow-up compared to 41.3% in the not-at-risk group, whilst injurious falls were reported by 63.2% of the not-at-risk group and by 59.7% of the at-risk group. At-risk individuals had a higher rate of falls (aIRR = 3.91, 95% CI: 3.30-4.64, P < .001) but a similar rate of injurious falls as the not-at-risk individuals (aIRR = 1.26, 95% CI: 0.93-1.71; P = .11). Not-at-risk individuals with slow gait speed sustained injurious falls at twice the rate (aIRR = 1.83, 95% CI: 1.12-3.91, P = .008) than those without slow gait speed.
Conclusions: Being screened as not-at-risk for falls does not mean no risk at all. Routinely and universally assessing gait speed could identify not-at-risk individuals who are likely to sustain injuries after a fall and could benefit from primary prevention.
期刊介绍：
Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.
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