OBJECTIVES Previous studies showed that peak expiratory flow (PEF) is associated with health-related outcomes in advanced age, but the extent to which it may be related to falls risk remains unclear. We aimed to detect the association between PEF and injurious falls in older adults and to explore the role of cognitive and physical deficits in this association. DESIGN Prospective study with a 6-year follow-up. SETTING AND PARTICIPANTS The study involves 2234 community-dwelling older adults with no history of pulmonary disease. METHODS For each study participant, we assessed the PEF at baseline, expressed as standardized residual (SR) percentile and derived from the normalization of residuals between the measured and predicted PEF values (based on individual age, sex, and body height); incident injurious falls over 6 years, from Hospital Discharge Diagnosis; and physical and cognitive functioning at the baseline and at 3- and 6-year follow-ups by evaluating walking speed, balance, chair stand, and Mini-Mental State Examination, respectively. RESULTS Over the follow-up, 232 individuals experienced injurious falls. Cox models indicated 7% higher risk of falls per each 10th reduction in PEF SR-percentile. The risk of injurious falls increased by more than twice for those who had PEF SR-percentile <10th as for values of 80th-100th (hazard ratio = 2.31, 95% confidence interval: 1.41-3.76). Physical deficits mediated 63% of the total effect of PEF on falls risk. CONCLUSIONS AND IMPLICATIONS Our findings suggest that low PEF is associated with higher risk of injurious falls in older adults, and most of this association is explained by balance or muscular strength deficits.

中文翻译：

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呼气峰值流量和老年人受伤性跌倒的风险：身体和认知缺陷的作用

目标 先前的研究表明，峰值呼气流量 (PEF) 与高龄人群的健康相关结果相关，但其与跌倒风险的相关程度尚不清楚。我们旨在检测 PEF 与老年人伤害性跌倒之间的关联，并探讨认知和身体缺陷在这种关联中的作用。设计 具有 6 年随访的前瞻性研究。设置和参与者 该研究涉及 2234 名没有肺部疾病史的社区老年人。方法 对于每个研究参与者，我们评估了基线时的 PEF，表示为标准化残差 (SR) 百分位数，并源自测量和预测 PEF 值之间的残差标准化（基于个体年龄、性别和身高）；事故伤害性跌倒超过 6 年，出院诊断；通过分别评估步行速度、平衡、椅子站立和简易精神状态检查，在基线和 3 年和 6 年的随访中评估身体和认知功能。结果 在随访期间，232 人经历了伤害性跌倒。Cox 模型表明，PEF SR 百分位数每降低 10 分，跌倒风险就会增加 7%。PEF SR-百分位<10th 的值与80th-100th 值相比，伤害性跌倒的风险增加了两倍以上（风险比= 2.31，95% 置信区间：1.41-3.76）。身体缺陷介导了 PEF 对跌倒风险总影响的 63%。结论和意义 我们的研究结果表明，低 PEF 与老年人发生伤害性跌倒的风险较高有关，