De Breucker S, Nkodo Mekongo Y P, Ibebeke B, Pepersack T
Clinique de Gériatrie, Hôpital Erasme, Bruxelles.
Rev Med Brux. 2007 May-Jun;28(3):177-82.
Falls are one of the most common problems that threaten the independence of older individuals. They usually occur when impairments in multiple domains compromise the compensatory ability of the individual, as is the case for many geriatric syndromes. A number of the physical conditions and environmental situations predispose to falls. The medical risk factors of falls are reviewed. Falls in older individuals are rarely due to a single cause. Mechanisms that maintain postural stability are altered with aging (balance, gait speed, cardiovascular function). Female gender, past history of a fall, cognitive impairment, lower extremity weakness, balance problems, psychotropic drug use, arthritis, history of stroke, orthostatic hypotension, dizziness, and anemia represent the most frequent causes of risk of falls. Physical examination should focus upon the above mentioned risk factors and also on the presence of orthostatic hypotension, visual acuity, hearing assessment, examination of the extremities for deformities or neuropathies, and carotid sinus hypersensitivity which contributes to falls in people with unexplained falls. In conclusion, assessment of older individual at risk of falls or who fall present medical specificities. However, these latter specificities should be included in a comprehensive assessment which focus on intrinsic and extrinsic factors. Interventional strategies including comprehensive and interdisciplinary assessment lead to effective prevention.
跌倒 是威胁老年人独立性的最常见问题之一。当多个领域的功能损害影响个体的代偿能力时，跌倒通常就会发生，许多老年综合征就是这种情况。一些身体状况和环境因素易导致跌倒。本文综述了跌倒的医学风险因素。老年人跌倒很少是由单一原因引起的。维持姿势稳定性的机制会随着年龄增长而改变（平衡、步态速度、心血管功能）。女性、既往跌倒史、认知障碍、下肢无力、平衡问题、使用精神药物、关节炎、中风史、体位性低血压、头晕和贫血是跌倒风险最常见的原因。体格检查应关注上述风险因素，还要关注是否存在体位性低血压、视力、听力评估、检查四肢有无畸形或神经病变，以及颈动脉窦过敏，后者在不明原因跌倒的人群中会导致跌倒。总之，对有跌倒风险或已发生跌倒的老年人进行评估有其医学特殊性。然而，这些特殊性应纳入针对内在和外在因素的全面评估中。包括全面和跨学科评估在内的干预策略可有效预防跌倒。
