地域在住自立高齢者における転倒リスクの関連要因とその性差 亀岡スタディ  [in Japanese] Fall risk factors and sex differences among community-dwelling elderly individuals in Japan A Kameoka study  [in Japanese]

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Author(s)

    • 伊達 平和 DATE Heiwa
    • 京都大学大学院文学研究科|日本学術振興会特別研究員 Graduate School of Letters, Kyoto University|Japan Society of Promotion for Science Research Fellow
    • 山田 陽介 YAMADA Yosuke
    • 国立研究開発法人医薬基盤・健康・栄養研究所国立健康・栄養研究所基礎栄養研究部 Department of Nutritional Science, National Institute of Health and Nutrition, National Institutes of Biomedical Innovation, Health and Nutrition
    • 山田 実 YAMADA Minoru
    • 筑波大学大学院人間総合科学研究科 Graduate School of Comprehensive Human Sciences, University of Tsukuba
    • 中谷 友樹 NAKAYA Tomoki
    • 立命館大学文学部・歴史都市防災研究所 College of Letters and Institute of Disaster Mitigation for Urban Cultural Heritage, Ritsumeikan University
    • 渡邊 裕也 WATANABE Yuya
    • 京都学園大学健康医療学部|京都府立医科大学大学院医学研究科 Faculty of Health and Medical Sciences, Kyoto Gakuen University|Graduate School of Medical Science, Kyoto Prefectural University of Medicine
    • 吉田 司 YOSHIDA Tsukasa
    • 亀岡市役所高齢福祉課|京都工芸繊維大学大学院工芸科学研究科 Senior Citizen's Welfare Section, Kameoka City|Graduate School of Science and Technology, Kyoto Institute of Technology

Abstract

<b>目的</b> 地域在住自立高齢者の転倒リスクとその関連要因および性差を検討した。<br/><b>方法</b> 京都府亀岡市の65歳以上の全高齢者の中で要介護 3 以上を除く18,231人に対して2011年 7~8 月に行った自記式留め置き式質問紙調査への回答者13,159人のうち(回収率72.2%),要支援・要介護認定者を除く「自立高齢者」12,054人について分析した。調査票は個別に配布し郵送で回収した。調査内容には,基本属性,鳥羽らによる転倒リスク簡易評価指標 5 項目,日常生活圏域ニーズ調査基本チェックリスト25項目,老研式活動能力指標13項目を用い,高齢者の諸機能や生活機能の低下の有無を示す 9 つの指標(①運動機能,②低栄養,③口腔機能,④閉じこもり,⑤物忘れ,⑥うつ傾向,⑦ IADL,⑧知的能動性,⑨社会的役割)で調査した。分析は,性,年齢別の転倒リスクとその関連要因および性差をカイ二乗検定とロジスティック回帰分析により把握し,9 つの評価指標を独立変数,年齢と教育年数を共変量,転倒リスクを従属変数とするロジスティック回帰分析(ステップワイズ法)を行って各要因による転倒リスクへの独立した影響を性別ごとに分析した。<br/><b>結果</b> 本調査回答者の過去 1 年間の転倒率は20.8%で,転倒リスク高群は26.6%であった。転倒リスクは,男女とも加齢とともに高くなり,女性はすべての年齢層において男性よりも高かった。また,男女とも,すべての評価指標と転倒リスクとの関連がみられ,それぞれの要因を調整した結果では,男性は運動機能,低栄養,口腔機能,物忘れ,うつ傾向,IADL に,女性は運動機能,口腔機能,物忘れ,うつ傾向,IADL に有意な関連がみられ,運動機能低下は男女とも最も強い要因であった。性差では,低栄養,口腔機能は男性の方に,IADL,知的能動性は女性の方に転倒リスクとの関連が強かった。<br/><b>結論</b> 地域在住自立高齢者の 5 人に 1 人は過去 1 年間に転倒を経験し,4 人に 1 人は転倒リスクを有していた。転倒リスクと 9 つすべての評価指標との間に有意な関連がみられ,とくに男女とも運動機能低下が最も大きかった。また,転倒リスクに影響する要因に性差がみられ,性別を考慮した支援策が必要と示唆された。

<b>Objectives</b> Although factors associated with falls might differ between men and women, no large-scale studies were conducted to examine the sex difference of risk factors for falls in Japanese elderly. The purpose of this study was to examine fall risk factors and sex differences among community-dwelling elderly individuals using a complete survey of the geriatric population in Kameoka city.<br/><b>Methods</b> A self-administered questionnaire survey was conducted with 18,231 community-dwelling elderly individuals aged 65 years or over in Kameoka city, Kyoto Prefecture, between July and August 2011, excluding people who were publicly certified with a long-term care need of grade 3 or higher. The questionnaire was individually distributed and collected via mail. Out of 12,159 responders (recovery rate of 72.2%), we analyzed the data of 12,054 elderly individuals who were not certified as having long-term care needs. The questionnaire was composed of basic attributes, a simple screening test for fall risk, the Kihon Check List with 25 items, and the Tokyo Metropolitan Institute of Gerontology (TMIG) index of competence with 13 items. These items were grouped into nine factors: motor function, malnutrition, oral function, houseboundness, forgetfulness, depression, Instrumental Activity of Daily Living (IADL), intellectual activities, and social role.<br/><b>Results</b> Of all the respondents, 20.8% experienced falls within the last year, and 26.6% were classified as having high fall risk. Fall risk increased with age in both sexes, and risk in all age groups was higher for women than for men. All factors were significantly associated with fall risk in both sexes. After controlling for these factors, a significant relationship was found between fall risk and motor function, malnutrition, oral function, forgetfulness, depression, and IADL in men and motor function, oral function, forgetfulness, depression, and IADL in women. The deterioration of motor function was associated with three-times-higher risk than non-deterioration of motor function. In addition, significant interaction was found in sex×malnutrition, oral function, IADL, and intellectual activities; malnutrition and low oral function were stronger factors in men than in women; and IADL and intellectual activities were stronger factors in women than in men.<br/><b>Conclusion</b> One in five community-dwelling independent elderly individuals experienced falls in the last year, and one in four had high fall risk. We found a significant relationship between fall risk and the nine factors, particularly deterioration of motor function in both sexes. Sex difference was observed for fall risk factors; therefore, a sex-specific support policy for fall prevention is necessary.

Journal

  • Nihon Koshu Eisei Zasshi(JAPANESE JOURNAL OF PUBLIC HEALTH)

    Nihon Koshu Eisei Zasshi(JAPANESE JOURNAL OF PUBLIC HEALTH) 62(8), 390-401, 2015

    Japanese Society of Public Health

Codes

  • NII Article ID (NAID)
    130005107059
  • NII NACSIS-CAT ID (NCID)
    AN00189323
  • Text Lang
    JPN
  • ISSN
    0546-1766
  • NDL Article ID
    026731663
  • NDL Call No.
    Z19-216
  • Data Source
    NDL  J-STAGE 
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