骨密度测试联合老年人运动功能量表-25评估筛查老年人基础运动障碍及跌倒风险:天津市6个社区1458例调查
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摘要
背景:老年人运动功能量表(geriatric locomotive function scale,GLFS)-25、平衡功能评定、步态测试等常用于筛查老年人运动功能障碍和预测跌倒风险的方法均属于主观评定方法,因此结合客观的评价指标能更为全面地反映老年人的运动功能状态和平衡功能。目的:探讨GLFS-25量表联合骨密度测试在筛查天津市6个社区老年人基础运动障碍和评估患者跌倒风险中的应用效果。方法:采用分区整群随机抽样调查法抽取天津市和平区、南开区的6个社区老年人1458例进行调查,根据GLFS-25得分情况将其分为运动功能障碍组(198例,GLFS-25≥16分)和非运动功能障碍组(1 260例,GLFS-25<16分)。比较两组调查对象的身高、体质量、体质量指数、体脂肪率、内脏脂肪面积等相关因素,比较两组受试者骨密度、跌倒次数、膝关节灵活度和下肢力量、平衡功能评分及步态分析,并进行相关性分析;采用受试者工作特征曲线分析GLFS-25联合骨密度测试诊断老年人基础运动障碍及跌倒风险的效能。结果与结论:(1)运动功能障碍组身高显著低于非运动功能障碍组、体质量指数和体脂肪率显著高于非运动功能障碍组(P <0.05),运动功能障碍组骨密度值显著低于非运动功能障碍组(t=7.467,P=0.000);(2)非运动功能障碍组的过去1年平均跌倒次数和跌倒危险指数显著低于运动功能障碍组,30 s内坐立姿势转换次数、自我平衡感觉评分显著高于运动功能障碍组(P均为0.000);非运动功能障碍组的总路程、平均步速、左右平均步长均显著高于运动功能障碍组,其左右步幅变异系数均显著低于运动障碍组(P <0.05);(3)Pearson相关性分析结果显示,GLFS-25评分、骨密度与身高、体质量指数和体脂肪率无明显相关性(P>0.05),GLFS-25评分与骨密度、自我平衡感觉、总路程、平均步速、左右平均步长均呈负相关,与跌倒次数、跌倒危险指数、左右步幅变异系数呈正相关(P <0.05);(4)受试者工作特征曲线曲线分析显示,GLFS-25联合骨密度预测运动功能障碍及跌倒风险的曲线下面积分别为0.895和0.903,均显著高于GLFS25和骨密度单独检测,其灵敏度分别提高至90.73%和90.15%;(5)结果说明,天津市市区社区老年人存在基础运动功能障碍者的比例较高,运动功能障碍患者的GLFS-25评分更高、骨密度更低,由于其膝关节灵活度和下肢力量及平衡能力更差,跌倒风险相应也更高,而GLFS-25联合骨密度测试在老年人基础运动障碍的筛查和跌倒风险评估预测中的效能更优。
BACKGROUND: Subjective assessments, such as 25-question Geriatric Locomotive Function Scale(GLFS-25), balance function assessment, and gait test, are commonly used to screen for motor dysfunction and predict the risk of falls in the elderly. Therefore, the combination of impersonal assessment indicators and these subjective assessments can fully reflect the motor and balance functions of the elderly. OBJECTIVE: To explore the application of GLFS-25 combined with bone mineral density test in screening for locomotive syndrome and risk of falls in the older adults. METHODS: A total of 1 458 elderly people who resided in six communities of Heping District, Tianjin, China were enrolled by the method of zoning cluster random sampling. According to the GLFS-25 scores, the subjects were divided into locomotive syndrome group(198 cases, GLFS-25 ≥ 16) and non-locomotive syndrome group(1 260 cases, GLFS-25 < 16). The height, weight, body mass index, body fat percentage, and visceral fat area were compared between the two groups. The bone mineral density, fall frequency, knee flexibility and lower limb strength, balance function and gait parameters were also tested and compared between the two groups. The Pearson method was used to analyze the correlation between GLFS-25 score, bone mineral density and fall frequency, the frequency of sitting posture conversion, gait parameters and balance function score in 30 seconds. Receiver operating characteristic curve was used to analyze the efficacy of GLFS-25 combined with bone mineral density test in the diagnosis of locomotive syndrome and fall risk in the elderly. RESULTS AND CONCLUSION:(1) Compared with the non-locomotive syndrome group, height, body mass index, and fat percentage were significantly higher in the locomotive syndrome group(P < 0.05), while the bone mineral density was significantly lower(t=7.467, P=0.000).(2) Compared with the locomotive syndrome group, the non-locomotive syndrome group showed significantly less fall frequency within 1 year and lower risk of falls, lower 30-second sitting/standing conversion frequency, worse self-balance feeling score(P=0.000), but longer total distance, faster step speed, and larger step size, and lower variation coefficient of the left and right strides(P < 0.05).(3) Pearson correlation analysis showed that there was no significant correlation between GLFS-25 score, bone mineral density and height, body mass index, and body fat percentage(P > 0.05). GLFS-25 score was negatively correlated with bone mineral density, self-balance feeling, total distance, average step speed, and average step length, but positively correlated with fall frequency, fall risk index, and variation coefficient of the left and right strides(P < 0.05).(4) Receiver operating characteristic curve analysis showed that the area under the curve of GLFS-25 combined with bone mineral density for prediction of locomotive syndrome and risk of falls was 0.895 and 0.903, respectively, which was significantly higher than that of GLFS-25 or bone mineral density test alone. And their sensitivity increased to 90.73% and 90.15%, respectively. Overall, the proportion of older adults with locomotive syndrome in Tianjin urban communities is relatively high. The patients with locomotive syndrome have higher GLFS-25 score, lower bone mineral density, lower knee flexibility, limb strength and balance, and a higher fall risk. GLFS-25 combined with bone mineral density test is therefore more effective in the screening of locomotive syndrome and fall risk assessment in the elderly.
BACKGROUND: Subjective assessments, such as 25-question Geriatric Locomotive Function Scale(GLFS-25), balance function assessment, and gait test, are commonly used to screen for motor dysfunction and predict the risk of falls in the elderly. Therefore, the combination of impersonal assessment indicators and these subjective assessments can fully reflect the motor and balance functions of the elderly. OBJECTIVE: To explore the application of GLFS-25 combined with bone mineral density test in screening for locomotive syndrome and risk of falls in the older adults. METHODS: A total of 1 458 elderly people who resided in six communities of Heping District, Tianjin, China were enrolled by the method of zoning cluster random sampling. According to the GLFS-25 scores, the subjects were divided into locomotive syndrome group(198 cases, GLFS-25 ≥ 16) and non-locomotive syndrome group(1 260 cases, GLFS-25 < 16). The height, weight, body mass index, body fat percentage, and visceral fat area were compared between the two groups. The bone mineral density, fall frequency, knee flexibility and lower limb strength, balance function and gait parameters were also tested and compared between the two groups. The Pearson method was used to analyze the correlation between GLFS-25 score, bone mineral density and fall frequency, the frequency of sitting posture conversion, gait parameters and balance function score in 30 seconds. Receiver operating characteristic curve was used to analyze the efficacy of GLFS-25 combined with bone mineral density test in the diagnosis of locomotive syndrome and fall risk in the elderly. RESULTS AND CONCLUSION:(1) Compared with the non-locomotive syndrome group, height, body mass index, and fat percentage were significantly higher in the locomotive syndrome group(P < 0.05), while the bone mineral density was significantly lower(t=7.467, P=0.000).(2) Compared with the locomotive syndrome group, the non-locomotive syndrome group showed significantly less fall frequency within 1 year and lower risk of falls, lower 30-second sitting/standing conversion frequency, worse self-balance feeling score(P=0.000), but longer total distance, faster step speed, and larger step size, and lower variation coefficient of the left and right strides(P < 0.05).(3) Pearson correlation analysis showed that there was no significant correlation between GLFS-25 score, bone mineral density and height, body mass index, and body fat percentage(P > 0.05). GLFS-25 score was negatively correlated with bone mineral density, self-balance feeling, total distance, average step speed, and average step length, but positively correlated with fall frequency, fall risk index, and variation coefficient of the left and right strides(P < 0.05).(4) Receiver operating characteristic curve analysis showed that the area under the curve of GLFS-25 combined with bone mineral density for prediction of locomotive syndrome and risk of falls was 0.895 and 0.903, respectively, which was significantly higher than that of GLFS-25 or bone mineral density test alone. And their sensitivity increased to 90.73% and 90.15%, respectively. Overall, the proportion of older adults with locomotive syndrome in Tianjin urban communities is relatively high. The patients with locomotive syndrome have higher GLFS-25 score, lower bone mineral density, lower knee flexibility, limb strength and balance, and a higher fall risk. GLFS-25 combined with bone mineral density test is therefore more effective in the screening of locomotive syndrome and fall risk assessment in the elderly.
引文
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[11]李萍,姜丽萍,陈颖颖,等.失能老年人长期照护家庭负担及影响因素[J].护理研究,2016,30(21):L2584-2587.
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[13]Iwaya T,Doi T,Seichi A,et al.Relationship between physician-judged functioning level and self-reported disabilities in elderly people with locomotive disorders.Qual Life Res.2016;26(1):35-43.
[14]隋建玲,周绍龙,李玉,等.山东省淄博市城区中老年人群骨密度变化及骨质疏松发生率调查[J].中国骨质疏松杂志,2016,22(10):1273-1276.
[15]Hosseini SR,Baghitabar N,Mirzapour A,et al.Hyponatremia,Bone Mineral Density and Falls in the Elderly;results from AHAP study.Rom J Intern Med.2017;56(1):41-46.
[16]Sayed SA,Khaliq A,MahmoodA.Evaluating The Risk Of Osteoporosis Through Bone Mass Density.JAMC.2016;28(4):730-733.
[17]闫岩,孙艳格,杜雪平,等.超声骨密度检查对社区绝经后妇女骨质疏松症筛查效果评价[J].中国全科医学,2016,19(14):1629-1632.
[2]Tano T,Ono K,Hiratsuka Y,et al.Retinal vessel diameters in a Japanese population:the Locomotive Syndrome and Health Outcome in Aizu Cohort Study.Acta Ophthalmol.2016;94(6):e432-41.
[3]赵鸣,王浩,何勇,等.养老机构老年人跌倒发生流行特征与危险因素分析[J].中华急诊医学杂志,2016,25(5):654-658.
[4]Tavares DR,Santos FC.Locomotive syndrome in the elderly:translation,cultural adaptation,and Brazilian validation of the tool 25-Question Geriatric Locomotive Function Scale.Rev Bras ReumatolEngl Ed.2017;57(1):56-63.
[5]梁雷超,吕娇娇,黄灵燕,等.认知-姿势控制双任务在老年人跌倒研究中的应用进展[J].中国康复理论与实践,2016,22(11):1289-1293.
[6]孙威,王疆娜,杨春荣,等.太极拳和快走练习对老年女性骨密度和骨代谢影响的跟踪研究[J].中国骨质疏松杂志,2017,23(8):1034-1040.
[7]张宁,李慧娟,张瑞丽.运动障碍综合征及其诊断评估预防研究现状[J].中国运动医学杂志,2016,35(2):189-191.
[8]陈奕,纽美娥,钱红英,等.五次坐立实验在慢性阻塞性肺疾病患者下肢功能评估中的初步应用[J].中国实用护理杂志,2016,32(8):566-570.
[9]林源,钮美娥,王丽.脑卒中患者平衡功能评定方法的应用进展[J].中国康复理论与实践,2016,22(6):667-671.
[10]刘郑,倪朝民,刘孟,等.脑卒中偏袒患者步态与站立平衡功能间的相关性分析[J].中华物理医学与康复杂志,2016,38(4):250-253.
[11]李萍,姜丽萍,陈颖颖,等.失能老年人长期照护家庭负担及影响因素[J].护理研究,2016,30(21):L2584-2587.
[12]张宁.老年人运动量表的汉化及在肌肉骨骼系统性疾病中的应用研究[D].石家庄:河北医科大学,2016:7-10.
[13]Iwaya T,Doi T,Seichi A,et al.Relationship between physician-judged functioning level and self-reported disabilities in elderly people with locomotive disorders.Qual Life Res.2016;26(1):35-43.
[14]隋建玲,周绍龙,李玉,等.山东省淄博市城区中老年人群骨密度变化及骨质疏松发生率调查[J].中国骨质疏松杂志,2016,22(10):1273-1276.
[15]Hosseini SR,Baghitabar N,Mirzapour A,et al.Hyponatremia,Bone Mineral Density and Falls in the Elderly;results from AHAP study.Rom J Intern Med.2017;56(1):41-46.
[16]Sayed SA,Khaliq A,MahmoodA.Evaluating The Risk Of Osteoporosis Through Bone Mass Density.JAMC.2016;28(4):730-733.
[17]闫岩,孙艳格,杜雪平,等.超声骨密度检查对社区绝经后妇女骨质疏松症筛查效果评价[J].中国全科医学,2016,19(14):1629-1632.
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