School of Population Health, The University of Queensland, Herston, Queensland 4006, Australia.
Int Psychogeriatr. 2013 Feb;25(2):215-27. doi: 10.1017/S1041610212001573. Epub 2012 Oct 3.
Globally, falls in older people are a leading cause of injury-related mortality and morbidity. Cognitive impairment is a well-known risk factor for falls in this population group. While there is now a large body of evidence to support effective interventions for falls reduction across care settings, very little is known about interventions in the vulnerable, but increasing population of cognitively impaired community-dwelling older people. Therefore, the purpose of this systematic review is to investigate interventions designed to reduce falls in community-dwelling, cognitively impaired older adults.
A literature search of databases was conducted to identify original research published in English, which met predefined inclusion and exclusion criteria for effective (non-pharmacological) falls prevention interventions in cognitively impaired community-dwelling people over 65 years of age. Data from the selected papers were extracted into data extraction tables and analyzed according to study characteristics, measures, results, and quality.
The review identified 11 studies providing data from 1,928 participants. Interventions included exercise, health assessment and management of risk, multi-component and cognitive behavioral programs, and hip protectors as falls risk reduction strategies. Seven of the selected studies showed an intervention effect in decreasing falls risk; however, only two of these showed a significant improvement in physical performance measures specifically in a cognitively impaired group.
The diversity of interventions, study designs, populations, and quality of the studies, which met inclusion criteria, resulted in conflicting evidence and inconclusive results for falls prevention interventions in this highly complex population.
在全球范围内，老年人跌倒导致的伤害相关死亡率和发病率居首位。认知障碍是该人群跌倒的已知危险因素。虽然现在有大量证据支持在各种护理环境中实施有效的跌倒预防干预措施，但对于认知障碍的社区居住的老年人这一脆弱但日益增加的人群，干预措施知之甚少。因此，本系统评价的目的是调查旨在减少认知障碍的社区居住的老年人跌倒的干预措施。
对数据库进行了文献检索，以确定符合预先设定的纳入和排除标准的研究，这些研究针对 65 岁以上认知障碍的社区居住者设计了有效的（非药物）跌倒预防干预措施。从选定的论文中提取数据到数据提取表中，并根据研究特征、措施、结果和质量进行分析。
该综述确定了 11 项研究，提供了 1928 名参与者的数据。干预措施包括运动、健康评估和风险管理、多组分和认知行为计划以及髋保护器作为降低跌倒风险的策略。选定的七项研究表明干预措施降低了跌倒风险，但只有两项研究表明在认知障碍组中特定的身体表现测量方面有显著改善。
符合纳入标准的研究设计、人群和研究质量的多样性导致了干预措施在这一高度复杂人群中预防跌倒的证据相互矛盾，结果不确定。
