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首页> 外文学位 >Facteurs de risque de chutes chez les aines vivant dans la communaute et ayant recours aux services de soutien a domicile Covariables dependantes du temps et evenements recurrents.
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Facteurs de risque de chutes chez les aines vivant dans la communaute et ayant recours aux services de soutien a domicile Covariables dependantes du temps et evenements recurrents.

机译：社区中老年人的跌倒风险因素是取决于时间和重复发生的事件而使用Covariate家庭支持服务的。

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摘要

Falls in the elderly represent a major problem. It is therefore not surprising that the identification of factors that may increase the risk of falls has received much attention. Frailer seniors who need support to live in the community remained nonetheless poorly documented, although more recently, the Quebec authorities have given high priority to interventions that target this population.;In this thesis, we review the existing methods and propose a Cox hazards extension. We apply it in the study of potential fall-risk factors associated with 959 community-dwelling seniors using home-care services. Finally, we compare the results of the proposed Wei, Lin, & Weissfeld (WLW) method with those of several other techniques, notably the conventional logistic regression, the pooled logistic regression, the negative binomial regression and the Andersen & Gill regression. At baseline and every six months thereafter, participants were visited at home in order to ascertain information about potential risk factors. Falls were monitored by use of a calendar and monthly phone calls. Baseline exposure variables and updated time-varying exposures include socio-demographic characteristics, BMI, nutritional risk, gait and balance, alcohol consumption, home hazards, and medications.;Almost all (99.6%) of participants showed at least one high risk factor. Exposure to multiple risks was frequent, with an average of 2.7 different high-risk factors per participant. The risk factors significantly associated to the risk of falling include male sex, age, history of falling, Berg balance score, BMI, use of benzodiazepines, number of home hazards and residential facility for seniors. Results demonstrate that the usual methods of analyzing risk factors for falling (any sort of fall as well as those leading to medical consultations) are inappropriate, as they produce considerable biases relative to the WLW model using time-dependent covariates. Bias for the considered effect measures comes from the manner in which the observed data (both measured exposures and health outcomes) was measured and defined as well as the way in which the statistical analysis took into account this information.;An additional part of the thesis was undertaken to identify risk profiles of subjects regarding the recurrence of falling, defined as participants who reported at least two falls within six months of initial assessment at entry in the study. A classification and regression tree analysis classified the population into five groups differing in risk of recurrent falling, based on history of falls in the three months prior to the initial interview, Berg balance score, type of housing, and usual alcohol consumption in the six months preceding study entry. The relative risks varied from 0.7 to 5.1. A subsequent survival analysis showed that the length of time before becoming a recurrent faller varies among risk profiles.;Risk factors for falls are usually identified by observational prospective studies. Their optimal identification is however complicated by the fact that exposure may vary during the follow-up, and that an individual may experience more than one event. Twenty years ago, some researchers attempted to sensitize their peers in this respect, but their efforts were vain. Researchers continue today to neglect these considerations and to use improper statistical techniques, focusing on the proportion of fallers or the time to first fall. In doing so, we discard a significant amount of relevant information.;This thesis discusses highly topical subjects about a target population and a fall-risk screening activity which are priorities in the public health sector in Quebec. We encourage researchers interested in the identification of risk of falls among the elderly to use the statistical method of Wei, Lin and Weissfeld because it takes into account updated time-varying exposures and multiple events. More research will be necessary to determine the best screening test for a given risk-factor in this setting and population.;Keywords : Accidental falls; Cox model; elderly; environmental hazards; home care services; multiple classification analysis, gait and balance; public health intervention; risk factors, survival analysis.
机译：老年人跌倒是一个主要问题。因此，毫不奇怪的是，可能增加跌倒风险的因素的识别受到了广泛关注。尽管最近，魁北克当局高度重视针对该人群的干预措施，但仍需要记录才能在社区中生活的体弱的年长者的文献很少。在本文中，我们回顾了现有的方法并提出了Cox危害扩展的建议。我们将其用于研究与959位使用居家护理服务的社区老年人相关的潜在跌倒风险因素。最后，我们将拟议的Wei，Lin和Weissfeld（WLW）方法的结果与其他几种技术的结果进行比较，其中包括传统的logistic回归，合并的logistic回归，负二项式回归和Andersen＆Gill回归。在基线以及此后的每六个月，要在家中访问参与者，以确定有关潜在危险因素的信息。通过使用日历和每月的电话来监视跌倒。基线暴露变​​量和更新的随时间变化的暴露包括社会人口统计学特征，BMI，营养风险，步态和平衡，饮酒，家庭危害和药物。几乎所有参与者（99.6％）显示出至少一种高危因素。经常暴露于多种风险中，每位参与者平均有2.7种不同的高风险因素。与跌倒风险显着相关的危险因素包括男性，年龄，跌倒史，伯格平衡评分，BMI，使用苯二氮卓类药物，家庭危害和老年人居所的数量。结果表明，分析跌倒危险因素（任何种类的跌倒以及导致就医的跌倒）的常用方法是不合适的，因为使用时变协变量，它们相对于WLW模型会产生相当大的偏差。所考虑的效果度量的偏倚来自于测量和定义观察到的数据（测量的暴露量和健康结果）的方式，以及统计分析考虑此信息的方式。旨在确定受试者跌倒复发的风险特征，定义为在进入研究初期评估后六个月内报告至少两次跌倒的受试者。分类和回归树分析基于首次访谈前三个月内的跌倒史，Berg平衡评分，房屋类型和六个月内的日常饮酒情况，将人群分为五组，其反复跌倒的风险不同之前的研究条目。相对风险从0.7到5.1不等。随后的生存分析表明，成为复发性跌倒前的时间长度因风险概况而异。;跌倒的风险因素通常由观察性前瞻性研究确定。然而，由于暴露可能在随访期间发生变化，而且一个人可能经历多个事件，因此他们的最佳识别变得复杂。二十年前，一些研究人员试图在这方面提高同龄人的意识，但他们的努力是徒劳的。今天，研究人员继续忽略这些考虑，并使用不正确的统计技术，重点关注跌倒者的比例或第一次跌倒的时间。这样做会丢弃大量的相关信息。本论文讨论了有关目标人群和跌落风险筛查活动的高度主题性话题，这是魁北克公共卫生部门的重点工作。我们鼓励对确定老年人跌倒风险感兴趣的研究人员使用Wei，Lin和Weissfeld的统计方法，因为该方法考虑了最新的随时间变化的暴露和多种事件。在这种情况下和人群中，对于给定的危险因素，最好的筛查试验是必须进行的更多研究。考克斯模型老年;环境危害;家庭护理服务；多种分类分析，步态和平衡；公共卫生干预；危险因素，生存分析。

著录项

  • 作者

    Leclerc, Bernard-Simon.;

  • 作者单位

    Universite de Montreal (Canada).;

  • 授予单位 Universite de Montreal (Canada).;
  • 学科 Health Sciences Aging.;Health Sciences Public Health.
  • 学位 Ph.D.
  • 年度 2010
  • 页码 287 p.
  • 总页数 287
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 肿瘤学;
  • 关键词

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