Influence of Residential Hilly Environments on Physical Performance and Fall Risks in the Elderly

• Main Authors: Pei-Ying Chao, 趙珮瑛
• Other Authors: 鄭尊仁
• Format: Others
• Language: en_US
• Published: 2010
• Online Access: http://ndltd.ncl.edu.tw/handle/14927171645394150725

碩士 === 國立臺灣大學 === 職業醫學與工業衛生研究所 === 98 === Objective Fall risks evaluation is the most important part of fall preventions programs in the elderly. However, the effects of hilly environments of residential area on physical mobility and fall risks in the elderly were poorly understood. The aim of this study is to determine the association of residential hilly environment with physical mobility and fall risks in the community-living elderly. Methods Design, Setting, and Participants A cross-sectional study was designed for investigation. Participants enrolled from Sep 2007 to May 2008 were the elderly aged at least 65 years old from community in a harbor city in northern Taiwan. Main Outcome Measure Self-reported fall histories in past one year, results of Timed Up-and-Go Test, residential altitude and parameters of hilly neighborhoods derived from calculation on Google Contour Map. Results There were 215 males and 255 female residents of the city participated in our study. After assessing the information of their address on the Google Contour Map, we found the higher altitude the subjects lived on, the better results of Time UP-and-Go Test observed. Odds ratio for TUGT abnormality was 0.296(95% confidence interval [C.I.] 0.136-0.643, p=0.002) in zones of altitude between 40 to 60 meters, and odds ratio for TUGT abnormality in zones over 60 meters was 0.266(95% C.I. 0.101-0.700, p=0.007), comparing to zones of altitude 20 meters and below. Subjects who had lived in zones with hilly neighborhoods were found to have less abnormal TUGT results that odds ratio for TUGT abnormality was 0.417 (95% C.I.0.184–0.945, p=0.036) where altitude difference was more than 100 meters in the neighboring area diameter 1000m. Higher zones of residential altitude over 60 meters were positively associated with greater risks of falls in past one year, odds ratio 2.340 (95% C.I. 1.032–5.307, p=0.042), when comparing to zones of residential altitude 20 meters and below. Besides, the presence of hilly neighborhoods has different influence on annual risk of falls according to zones of residential altitude. In zones of altitude below 40 meters, greater altitude difference in neighboring area was negatively associated with annual risk of falls. As comparing to non-hilly areas, altitude difference of 20 meters in neighboring area diameter 500 meters had lower risk of falls in past one year, odds ratios 0.314(95% C.I. 0.111-0.892, p=0.03). And the risk was also lower with altitude difference 40 meters in neighboring area diameter 500 meters with odds ratio 0.217(95%C.I. 0.070-0.617, p=0.008). Similar results were observed in neighboring area diameter 1000meters that annual risk of falls in past one year was lower when altitude difference reached 60 meters, odds ratio 0.175(95%C.I. 0.045-0.681,p=0.012), when comparing to altitude difference 0~20 meters. When altitude difference reached 80 meters in neighboring area diameter 1000 meters, the odds ratio for annual risk of falls was 0.135(95% C.I.0.030-0.603, p=0.009). On the other hand, for those who had lived in zones of altitude 40 meters and higher, greater altitude difference in neighboring area was significantly associated with increased annual risk of falls. In residential altitude 40 and higher, when comparing to residents with even neighboring areas, residents who has altitude difference of 40 meters in Near Neighborhoods had greater risk of falls, odds ratio 4.398(95% C.I. 0.016-19.030, p=0.048). Conclusions Hilly living environments have an influence on both physical performance and fall risks in the elderly. Both in zones of higher altitudes the elderly lives, or with hilly neighborhoods they have nearby, the better mobility and balance function were observed. The elderly who lived in zones of higher altitudes had greater risk of falls. However, parameters of hilly neighborhoods have difference influence on annual risk of falls according to zones of residential altitude. Decreased risk of falls was observed in places with hilly neighborhoods in lower zones of altitude, but increased risk of falls in the elderly was observed in places with hilly residential neighborhoods in higher zones of altitude on the contrary.