步态和平衡功能对上海社区老年人衰弱的预测效能

doi:10.3969/j.issn.1006-9771.2024.06.014

摘要/Abstract

摘要：

目的探讨步态和平衡功能对上海市社区65岁以上老年人衰弱的预测价值。

方法 2022年12月至2023年4月在上海市社区招募65岁以上老年人414例，采用自设问卷、Fried衰弱表型量表、计时起立-行走测试(TUGT)、单腿站立测试(OLST)进行调查，对衰弱的影响因素进行多元Logistic回归分析。

结果衰弱前期和衰弱的发生率分别为62.8%和10.9%。居住农村、高龄、月均收入低、吸烟、久坐、无规律运动是社区老年人衰弱的风险因素；衰弱老年人TUGT时间提高(P < 0.05)，闭眼OLST时间降低(P < 0.05)。TUGT联合闭眼OLST预测衰弱的曲线下面积为0.846 (95%CI 0.808~0.884, P < 0.001)，最佳阈值时敏感性0.726，特异性0.817。

结论步态和平衡功能可能是预测上海社区65岁以上老年人衰弱有意义的因子。

关键词: 步态, 平衡, 衰弱, 社区, 老年人, 风险

Abstract:

Objective To explore the predictive value of gait and balance on the frailty in community-dwelling older adults aged 65 years and older in Shanghai.

Methods A total of 414 community-dwelling older adults aged 65 years or older were recruited from Shanghai, from December, 2022 to April, 2023. They were investigated with Fried's Frailty Phenotype Scale, Timed Up and Go Test (TUGT), one leg standing test (OLST) and self-designed questionnaire. The factors related to frailty were analyzed using multivariate Logistic regression.

Results The prevalence of pre-frailty and frailty were 62.8% and 10.9%, respectively. Living in rural residence, older age, low income, smoking, sedentary lifestyle and no regular exercise were the risk factors for frailty among community-dwelling older adults. Time of TUGT increased, and time of closed eyes OLST descreased respectively in the frail older adults (P < 0.05). The area under curve was 0.846 (95% CI 0.808 to 0.884, P < 0.001) as prediction for frailty using the combination of TUGT and closed eye OLST, with a sensitivity of 0.726 and a specificity of 0.817 at the optimal threshold.

Conclusion Gait and balance may be a valuable predictor of frailty in community-dwelling older adults in Shanghai.

Key words: gait, balance, frailty, community-dwelling, older adults, risk

中图分类号:

R592

温娜娜, 张芯慧, 龙清, 王雨豪, 余群萍, 张晗淳, 郑国华. 步态和平衡功能对上海社区老年人衰弱的预测效能[J]. 《中国康复理论与实践》, 2024, 30(6): 731-736.

WEN Nana, ZHANG Xinhui, LONG Qing, WANG Yuhao, YU Qunping, ZHANG Hanchun, ZHENG Guohua. Predictive value of gait and balance on frailty in community-dwelling older adults in Shanghai, China[J]. Chinese Journal of Rehabilitation Theory and Practice, 2024, 30(6): 731-736.

图/表 4

表1

表2

两组步态与平衡功能比较"

变量	组别	n	$x - ± s$	t值	P值
TUGT/s	无衰弱	109	8.01±1.92	6.806	< 0.001
	有衰弱	305	10.95±6.80
睁眼OLST/s	无衰弱	109	11.81±17.67	0.360	0.719
	有衰弱	305	10.99±26.43
闭眼OLST/s	无衰弱	109	6.28±10.10	2.080	0.040
	有衰弱	305	4.22±3.34

表2

表3

表4

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变量	n	变量	n	变量	n
性别		受教育年限/年		吸烟
男	227	< 5	234	否	247
女	187	5~10	148	是	167
年龄/岁		> 10	32	饮酒
65~69	142	月收入/元		否	304
70~74	154	< 2000	260	是	110
≥ 75	118	2000~6000	146	衰弱
居住地		> 6000	8	无	109
城镇	77	婚姻状况		衰弱前期	260
农村	337	已婚	358	衰弱	45
		独居或其他	56

变量	无衰弱(n = 109)	有衰弱(n = 305)	OR值	95% CI	P值	变量	无衰弱(n = 109)	有衰弱(n = 305)	OR值	95% CI	P值
性别(男)	53	174	1.000			每日久坐(< 3.5 h)	64	117	1.000
女	56	131	0.713	0.459~1.105	0.130	3.5~7 h	41	105	1.401	0.873~2.247	0.162
年龄(65~69岁)	54	88	1.000			> 7 h	4	83	11.350	3.978~32.389	< 0.001
70~74岁	43	111	1.584	0.972~2.582	0.065	规律运动(无)	11	129	1.000
≥ 75岁	12	106	5.420	2.279~10.768	< 0.001	有	98	176	0.153	0.079~0.297	< 0.001
居住地(城镇)	37	40	1.000			营养(正常)	78	194	1.000
农村	72	265	3.405	2.029~5.712	< 0.001	不良	31	111	1.440	0.893~2.320	0.134
受教育年限(<5年)	52	182	1.000			睡眠质量(≤ 5分)	72	165	1.000
5~10年	41	107	0.383	0.175~0.837	0.016	> 5分	37	140	1.651	1.047~2.605	0.031
> 10年	16	16	0.286	0.134~0.610	0.001	慢性病(无)	43	72	1.000
月收入(< 2000元)	44	216	1.000			有	66	233	1.452	1.150~1.833	0.002
2000元~6000元	61	85	0.718	0.173~2.982	0.648	抑郁(无)	76	221	1.000
> 6000元	4	4	0.204	0.049~0.846	0.028	有	33	84	0.875	0.542~1.414	0.586
婚姻状况(已婚)	97	261	1.000			药物(不服用)	45	122	1.000
独居及其他	12	44	1.363	0.691~2.689	0.372	服1种	41	110	0.990	0.603~1.624	0.967
既往工作(体力劳动)	91	276	1.000			服2种及以上	23	73	1.171	0.655~2.091	0.594
脑力劳动及其他	18	29	0.531	0.282~1.001	0.051	新冠感染(无)	45	130	1.000
吸烟(否)	76	171	1.000			有	64	175	0.947	0.607~1.475	0.808
是	33	134	1.805	1.131~2.879	0.013	手术史(无)	81	213	1.000
饮酒(否)	80	224	1.000			有	28	92	1.249	0.762~2.049	0.377
是	29	81	0.998	0.608~1.637	0.992	健康自评(健康)	61	82	1.000
						亚健康	48	223	3.456	2.193~5.448	< 0.001

变量	B	SE	P值	Wald	OR值	95%CI
常量	-1.475	0.709	0.038	4.324	0.229
TUGT	0.268	0.062	< 0.001	18.842	1.307	1.158~1.474
闭眼OLST	-0.073	0.034	0.034	4.493	0.930	0.870~0.995
居住地(城镇)	0.748	0.334	0.025	5.011	2.113	1.098~4.067
年龄(70~74岁)	1.039	0.411	0.011	6.399	2.826	1.264~6.318
月收入(< 2000元)	-0.643	0.294	0.029	4.792	0.526	0.296~0.935
吸烟(无吸烟)	0.929	0.295	0.002	9.922	2.533	1.421~4.517
规律运动(无规律运动)	-1.199	0.381	0.002	9.924	0.301	0.143~0.636
健康自评(健康)	0.694	0.276	0.012	6.334	2.002	1.166~3.436