背景:移动性限制(例如,使用轮椅)与老年人的功能独立性和生活质量下降密切相关。流动性的调节与多种神经生理和社会人口统计学因素有关。我们在此旨在描述这些因素与老年人活动受限风险的关系。
方法:在这项纵向研究中,668名基线时活动完整的老年人完成了临床特征的基线评估,认知功能,睡眠质量,日常生活活动(ADL),行走性能,血压逐级跳动,和大脑的结构核磁共振成像。然后,其中506人(平均年龄=70.7±7.5岁)对行动不便的后续访谈做出了回应(定义为使用轮椅,甘蔗,或者步行者,或残疾并躺在床上)后18±3.5个月。进行Logistic回归分析以检查基线特征与随访活动限制之间的关系。
结果:在基线时,与完整移动性组(n=475)相比,行动不便组(n=31)年龄较大,ADL和蒙特利尔认知评估(MoCA)得分较低,匹兹堡睡眠质量指数(PSQI)得分更高,心血管和脑血管功能较差,步行速度较慢(ps<0.05)。Logistic回归分析表明,有跌倒史的参与者,不受控制的高血压,和/或更大的Fazekas量表(优势比(ORs):1.3〜13.9,95%置信区间(CI)=1.1〜328.2),走得慢,和/或基线时ADL评分较低(ORs:0.0026~0.9;95CI:0.0001~0.99),活动受限的风险显著增加(p<0.05;VIFs=1.2~1.9)。
结论:这些发现提供了潜在风险因素的新概况,包括血管特征,心理认知和运动表现,为了在不久的将来发展老年人的行动不便,最终帮助设计适当的临床和康复计划,以应对该人群的流动性。
BACKGROUND: Mobility limitations (e.g., using wheelchair) have been closely linked to diminished functional independence and quality of life in older adults. The regulation of mobility is pertaining to multiple neurophysiologic and sociodemographic factors. We here aimed to characterize the relationships of these factors to the risk of restricted mobility in older adults.
METHODS: In this longitudinal study, 668 older adults with intact mobility at baseline completed the baseline assessments of clinical characteristics, cognitive function, sleep quality, activities of daily living (ADL), walking performance, beat-to-beat blood pressure, and structural MRI of the brain. Then 506 of them (mean age = 70.7 ± 7.5 years) responded to the follow-up interview on the mobility limitation (as defined by if using wheelchair, cane, or walkers, or being disabled and lying on the bed) after 18 ± 3.5 months. Logistic regression analyses were performed to examine the relationships between the baseline characteristics and the follow-up mobility restriction.
RESULTS: At baseline, compared to intact-mobility group (n = 475), restricted-mobility group (n = 31) were older, with lower score of ADL and the Montreal Cognitive Assessment (MoCA), greater score of Pittsburgh Sleep Quality Index (PSQI), poorer cardio- and cerebral vascular function, and slower walking speeds (ps < 0.05). The logistic regression analysis demonstrated that participants who were with history of falls, uncontrolled-hypertension, and/or greater Fazekas scale (odds ratios (ORs):1.3 ~ 13.9, 95% confidence intervals (CIs) = 1.1 ~ 328.2), walked slower, and/or with lower ADL score (ORs: 0.0026 ~ 0.9; 95%CI: 0.0001 ~ 0.99) at baseline, would have significantly greater risk of restricted mobility (p < 0.05; VIFs = 1.2 ~ 1.9).
CONCLUSIONS: These findings provide novel profile of potential risk factors, including vascular characteristics, psycho-cognitive and motor performance, for the development of restricted mobility in near future in older adults, ultimately helping the design of appropriate clinical and rehabilitative programs for mobility in this population.