Fernando Eresha, Fraser Michelle, Hendriksen Jane, Kim Corey H, Muir-Hunter Susan W
School of Physical Therapy, University of Western Ontario, London, Ont.
Physiother Can. 2017;69(2):161-170. doi: 10.3138/ptc.2016-14.
People with dementia fall more often than cognitively healthy older adults, but their risk factors are not well understood. A review is needed to determine a fall risk profile for this population. The objective was to critically evaluate the literature and identify the factors associated with fall risk in older adults with dementia. Articles published between January 1988 and October 2014 in EMBASE, PubMed, PsycINFO, and CINAHL were searched. Inclusion criteria were participants aged 55 years or older with dementia or cognitive impairment, prospective cohort design, detailed fall definition, falls as the primary outcome, and multi-variable regression analysis. Two authors independently reviewed and extracted data on study characteristics, quality assessment, and outcomes. Adjusted risk estimates were extracted from the articles. A total of 17 studies met the inclusion criteria. Risk factors were categorized into demographic, balance, gait, vision, functional status, medications, psychosocial, severity of dementia, and other. Risk factors varied with living setting and were not consistent across all studies within a setting. Falls in older adults with dementia are associated with multiple intrinsic and extrinsic risk factors, some shared with older adults in general and others unique to the disease. Risk factors vary between community- and institution-dwelling samples of adults with dementia or cognitive impairment.
与认知健康的老年人相比，患有痴呆症的人跌倒的频率更高，但人们对其风险因素了解不足。需要进行一项综述来确定该人群的跌倒风险概况。目的是严格评估文献，并确定与老年痴呆症患者跌倒风险相关的因素。检索了1988年1月至2014年10月期间发表在EMBASE、PubMed、PsycINFO和CINAHL上的文章。纳入标准为年龄在55岁及以上、患有痴呆症或认知障碍的参与者、前瞻性队列设计、详细的跌倒定义、以跌倒为主要结局以及多变量回归分析。两位作者独立审查并提取了关于研究特征、质量评估和结局的数据。从文章中提取了调整后的风险估计值。共有17项研究符合纳入标准。风险因素分为人口统计学、平衡、步态、视力、功能状态、药物、心理社会、痴呆症严重程度及其他因素。风险因素因生活环境而异，在同一环境中的所有研究中并不一致。患有痴呆症的老年人跌倒与多种内在和外在风险因素相关，其中一些因素与一般老年人共有，另一些则是该疾病所特有的。在患有痴呆症或认知障碍的成年人中，社区居住样本和机构居住样本的风险因素有所不同。
