Clinical and Molecular Osteoporosis Research Unit, Department of Orthopedics and Clinical Sciences, Skåne University Hospital, Lund University, 205-02 Malmö, Sweden.
Osteoporos Int. 2013 Mar;24(3):747-62. doi: 10.1007/s00198-012-2256-7. Epub 2013 Jan 8.
The proportion of elderly in the society increases and fall frequency increases with advancing age. Many falls result in fractures and also soft tissue injuries, longstanding pain, functional impairment, reduced quality of life, increased mortality, and excess in healthcare costs. Due to the magnitude of these negative effects, a variety of single- and multicomponent fall-preventive intervention programs has been initiated.This review identifies programs that, in randomized controlled trials (RCTs), have been shown with fall-reductive effects.The most effective strategies in community-dwelling elderly include regular physical training with program that includes several different training modalities. Modification of the overall or patient-specific risk factor profile in home hazard modification program has been proven to decrease fall risk in community-living elderly. The elderly in the community benefit also from wearing antislip shoe devices when walking in icy conditions, from adjustment of psychotropic medication, and from structured modification of multipharmacy. If vitamin D levels in blood are low, supplementation is beneficial as is the first eye cataract surgery and pacemaker implantation in patients with cardioinhibitory carotid sinus hypersensitivity. In addition to modification of specific risk factors, generalized and individualized multifactorial preventive programs, all including some sort of physical training, have been found to decrease the fall risk. In summary, there is now strong evidence in the literature that structured fall-preventive programs in the elderly, especially in high-risk groups, are beneficial in reducing both the number of fallers and the number of falls in community.
随着年龄的增长，社会中老年人的比例增加，跌倒的频率也随之增加。许多跌倒导致骨折，还会造成软组织损伤、长期疼痛、功能障碍、生活质量下降、死亡率增加和医疗保健费用增加。由于这些负面影响的巨大程度，已经启动了各种单一和多成分的预防跌倒干预计划。本综述确定了在随机对照试验 (RCT) 中显示出具有降低跌倒效果的计划。在社区居住的老年人中，最有效的策略包括定期进行身体训练，训练计划包括几种不同的训练方式。在家庭危险修正计划中修正整体或特定患者的风险因素谱，已被证明可以降低社区居住的老年人的跌倒风险。在社区中，老年人在冰面行走时穿着防滑鞋设备、调整精神药物和对多药物进行结构化修改也受益。如果血液中的维生素 D 水平较低，则补充维生素 D 有益，在患有抑制性颈动脉窦过敏的患者中进行第一次白内障手术和心脏起搏器植入也有益。除了修正特定的风险因素外，还发现一般和个体化的多因素预防计划，包括某种形式的身体训练，都可以降低跌倒风险。总之，目前有强有力的文献证据表明，老年人的结构化预防跌倒计划，特别是在高风险人群中，可以降低跌倒人数和跌倒次数。
