Gravesande Janelle, Richardson Julie
a School of Rehabilitation Science , McMaster University , Hamilton , Ontario , Canada.
Disabil Rehabil. 2017 Jul;39(15):1459-1465. doi: 10.1080/09638288.2016.1199741. Epub 2016 Jul 6.
To identify the non-pharmacological risk factors for falling in older adults with type 2 diabetes mellitus (DM2).
A systematic review of randomized controlled trials, prospective cohort studies, cross-sectional studies and before/after studies was conducted. Eligible studies identified non-pharmacological risk factors for falling in older adults with DM2. Medline, Embase, Pubmed and CINAHL were searched for relevant studies published through December 2015. Reference lists were also searched for relevant studies. Search terms were DM2, risk factors, falls and falling, older adults, aging, non-insulin dependent diabetes mellitus, accidental falls and trip. Publication language was restricted to English.
Thirteen studies met the inclusion criteria: four cross-sectional, six prospective cohorts, two randomized controlled trials and one before/after study. These studies included a total of 13,104 participants, ≥50 years. The most common risk factors for falling were impaired balance, reduced walking velocity, peripheral neuropathy and comorbid conditions. However, lower extremity pain, being overweight and comorbid conditions had the greatest impact on fall risk.
Interventions to reduce falling in older adults with type 2 diabetes mellitus should focus on reducing lower extremity pain, reducing body weight and managing comorbid conditions. Implications for Rehabilitation Diabetes mellitus: • Older adults with type 2 diabetes mellitus (DM2) have a higher risk for falling than older adults without. • Older adults with DM2 are more likely to suffer serious injuries when they fall. • Comprehensive risk factor identification is necessary for rehabilitation professionals to accurately determine whether their clients are at risk for falling. • Rehabilitation professionals also need to tailor interventions based on the client's risk factors in order to effectively reduce falls and fall-related injuries.
确定2型糖尿病（DM2）老年患者跌倒的非药物风险因素。
对随机对照试验、前瞻性队列研究、横断面研究及前后对照研究进行系统评价。纳入的研究需确定DM2老年患者跌倒的非药物风险因素。检索了截至2015年12月发表的相关研究的Medline、Embase、Pubmed和CINAHL数据库。还检索了参考文献列表中的相关研究。检索词包括DM2、风险因素、跌倒、老年患者、衰老、非胰岛素依赖型糖尿病、意外跌倒和绊倒。发表语言限于英语。
13项研究符合纳入标准：4项横断面研究、6项前瞻性队列研究、2项随机对照试验和1项前后对照研究。这些研究共纳入13104名年龄≥50岁的参与者。最常见的跌倒风险因素为平衡功能受损、步行速度减慢、周围神经病变和合并症。然而，下肢疼痛、超重和合并症对跌倒风险影响最大。
降低2型糖尿病老年患者跌倒风险的干预措施应侧重于减轻下肢疼痛、减轻体重和控制合并症。康复治疗的意义
• 2型糖尿病（DM2）老年患者比无糖尿病的老年患者跌倒风险更高。
• DM2老年患者跌倒时更易受重伤。
• 康复专业人员需要全面识别风险因素，以准确判断其患者是否有跌倒风险。
• 康复专业人员还需根据患者的风险因素制定个性化干预措施，以有效减少跌倒及跌倒相关损伤。
