背景:年龄相关性听力损失(AAHL)和周围神经病(PN)在老年患者中很常见,两者都与平衡受损有关,falls,过早死亡。本研究的目的是记录老年初级保健患者中AAHL的患病率和严重程度,并探索AAHL之间的关联,PN,balance,falls,和死亡率。
方法:我们分析了1999年从参加俄克拉荷马州成年成年人健康结果纵向评估(OKLAHOMA)研究的实践中招募的793名初级保健患者获得的信息。现有数据包括人口和健康信息,跌倒和住院史,测听法,平衡测试,检查周围神经,50英尺定时步态,以及长达22个日历年和8106人年随访的死亡日期。比例危险(PH)和结构方程模型(SEM)用于检查AAHL之间的关联,PN,balance,步态时间,和死亡率。
结果:793名参与者中有501名(63%)患有AAHL。另外156(20%)的频率较低,32(4%)的频率较低。中度或重度AAHL患者和PN患者255(32%)的平衡受损(p<0.0001),步态时间增加(p=0.0001),和减少生存时间(p<0.0001)。在PH模型中,AAHL和PN均与早期死亡率相关(H.RS.[95%C.I.]:分别为1.36[1.13-1.64]和1.32[1.10-1.59])。中度或重度AAHL和PN的组合,在24%的参与者中,预测的死亡率比单独预测的死亡率要早(O.R.[95%C.I.I]1.55[1.25-1.92])。在SEM模型中,中度或重度AAHL和PN对生存的影响是介导的,在某种程度上,通过失去平衡。
结论:听力损失和PN,都常见于老年患者,似乎与过早死亡独立相关。这些关联可能部分是由受损的平衡介导的。机制可能是多重和复杂的。
BACKGROUND: Both age-associated hearing loss (AAHL) and peripheral neuropathy (PN) are common in older patients, and both are associated with impaired balance, falls, and premature mortality. The objectives of this study were to document the prevalence and severity of AAHL in older primary care patients, and to explore associations between AAHL, PN, balance, falls, and mortality.
METHODS: We analyzed information obtained in 1999 from 793 primary care patients recruited from practices participating in the Oklahoma Longitudinal Assessment of the Health Outcomes of Mature Adults (OKLAHOMA) Studies. Available data included demographic and health information, history of falls and hospitalizations, audiometry, balance testing, examination of the peripheral nerves, 50 foot timed gait, and dates of death up to 22 calendar years and 8106 person-years of follow-up. Proportionate hazards (PH) and structural equation modeling (SEM) were used to examine associations between AAHL, PN, balance, gait time, and mortality.
RESULTS: 501 of the 793 participants (63%) had AAHL. Another 156 (20%) had low frequency and 32 (4%) had unilateral deficits. Those with moderate or severe AAHL and the 255 (32%) with PN had impaired balance (p < 0.0001), increased gait time (p = 0.0001), and reduced survival time (p < 0.0001). In the PH model, both AAHL and PN were associated with earlier mortality (H.Rs. [95% C.I.]: 1.36 [1.13-1.64] and 1.32 [1.10-1.59] respectively). The combination of moderate or severe AAHL and PN, present in 24% of participants, predicted earlier mortality than predicted by either deficit alone (O.R. [95% C.I.I] 1.55 [1.25-1.92]). In the SEM models, the impacts of both moderate or severe AAHL and PN on survival were mediated, in part, through loss of balance.
CONCLUSIONS: Hearing loss and PN, both common in older patients, appear to be independently and additively associated with premature mortality. Those associations may be mediated in part by impaired balance. The Mechanisms are likely multiple and complex.