| Background and purpose:China is the country with the largest aging population in the world,and the degree of aging is increasing.The health problems of the older adults are still the key to the current social health problems.Among them,falls are one of the most common risk factors for the older adults.According to reports,the annual incidence of falls among the older adults over 65 is as high as 30%,while the incidence of injuries in the older adults after falls is about 50%.The injury caused by the fall of the older adults has become one of the major causes of illness and death worldwide,and it has also greatly increased the burden on society and families.Considering the high incidence and serious consequences of falls,avoiding or delaying the occurrence of falls is an urgent public health problem.Risk factor assessment and individualized intervention for changeable risk factors are key strategies to prevent falls.A large number of studies have confirmed that falls are affected by many factors.Among them,mental health and physical activity are important internal risk factors for falls in the older adults.Therefore,this study aims to explore the correlation and interaction with falls from the perspective of physical activity and some psychological factors,so as to better prevent and effectively reduce the occurrence of falls in the older adults.Methods:In this study,the target population is the older adults aged 65 and above.The population in this age group has low mobility and relatively fixed living environment and habits,which is suitable for long-term observation.The local hospital and committee shall be notified in various ways to fully recruit the subjects.The information related to the subject's fall was obtained through the interview,and the fall was defined as sudden,involuntary and unintentional posture change,falling to the ground or on a lower plane.According to the classification of falls in the international classification of diseases(ICD-10),falls include falls from one plane to another and falls in the same plane.Record the number of falls of the subjects in the last year,and divide the population into "no falls","fall 1 time" and "fall?2 times".Ask the subject whether there is a psychological situation of fear of falling through specific questions,that is,ask the subject "are you usually afraid of falling" or "are you afraid of falling".The answer to this question is divided into three options:not afraid,a little afraid and very afraid.The physical activity ability test analyzes the muscle strength,walking function and balance ability of the older adults through standardized field tests,including grip strength,timed up to go test(TUGT),short physical performance battery(SPPB),etc.SPSS 26.0 was used for statistical description and data analysis.In order to verify the correlation among physical activity,fear and fall of the older adults,logistic regression analysis was carried out.In addition,the steps of establishing the mediation model further analyze the potential interaction between the three factors.The significance level was P<0.05.Result:This study conducted a baseline test on the older adults in four natural villages in Chongming District,Shanghai from May to September 2020,and included 1043 older adults aged?65 years into the analysis sample.During the follow-up in 2021,657 people were included in the follow-up analysis sample,and the follow-up rate was about 66.16%.In the cross-sectional study,we used logistic regression to analyze the correlation between physical activity,fear of falling and falling in the older adults.After adjusting for confounding factors,we still found that SPPB test scores(P<0.001)and fear of falling(P<0.001)were significantly correlated with falls in the past year.After analyzing the SPPB test items,it was found that the static balance score was related to the fall(P=0.028,or=0.802,95%CI:0.659,0.976),and the walking speed was related to the fall(P<0.001,or=0.547,95%CI:0.416,0.718).The degree of fear of falling was also highly correlated with the situation of falling,and there was a close relationship between some fear and falling(P=0.001,or=1.868,95%CI:1.289,2.706);The older adults who were very afraid of falling were also more related to fall(P<0.001,or=4.452,95%CI:2.413,8.213).After further analyzing the relationship between physical activity,fear and falls,it was found that fear of falls could play a significant intermediary role between physical activity and falls.The direct effect of fear of falling between the total score of SPPB test and falling was-0.330(95%CI:0.0524,-0.0136),the total effect was-0.0425(95%CI:-0.0620,-0.0231),and the mediated effect was 22.35%.In the longitudinal study,after adjusting for confounding factors,it was found that the total score of SPPB test scores were related to falls after one year(P=0.021),while the static balance test of baseline SPPB test was also related to falls(P=0.048),but there was no significant correlation between walking speed and chairs standing.In addition,the older adults who were not afraid(P=0.001)and very afraid(P=0.034)of falls were also associated with the occurrence of falls in the following year.The results of mediation analysis showed that fear of falling had a significant mediating effect on the total SPPB score and the number of falls in the following year.The direct effect was-0.0211(95%CI:-0.0422,-0.0001),the total effect was-0.0257(95%CI:-0.0465,-0.0048),and the mediating effect was 17.51%.Conclusion:Falls still have a high incidence among the older adults in some suburban communities in Shanghai.In the process of preventing and reducing the incidence of falls,screening related risk factors is still a key step.Fear of falling and physical activity decline are important psychological and behavioral factors related to falling.In this study,through the establishment of cross-sectional and longitudinal studies,we further confirmed the relationship between physical activity,fear of falling and falls,the older adults with worse physical activity ability and higher fear are more likely to fall. |
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