Scott Kenneth A, Rogers Eli, Betz Marian E, Hoffecker Lilian, Li Guohua, DiGuiseppi Carolyn
Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
Department of Emergency Medicine, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado.
J Am Geriatr Soc. 2017 Dec;65(12):2596-2602. doi: 10.1111/jgs.15047. Epub 2017 Sep 5.
To examine associations between falls and subsequent motor vehicle crashes (MVCs), crash-related injuries, driving performance, and driving behavior.
Systematic review and metaanalysis.
Observational studies including drivers aged 55 and older or with a mean age of 65 and older.
Two authors independently extracted study and participant characteristics, exposures, and outcomes and assessed risk of bias. Pooled risk estimates for MVCs and MVC-related injuries were calculated using random-effects models. Other results were synthesized narratively.
From 3,286 potentially eligible records, 15 studies (N = 27-17,349 subjects) met inclusion criteria. Risk of bias was low to moderate, except for cross-sectional studies (n = 3), which all had a high potential for bias. A fall history was associated with a significantly greater risk of subsequent MVC (summary risk estimate = 1.40, 95% confidence interval (CI) = 1.20-1.63; I = 28%, N = 5 studies). One study found a significantly greater risk of MVC-related hospitalizations and deaths after a fall (hazard ratio = 3.12, 95% CI = 1.71-5.69). Evidence was inconclusive regarding an association between falls and driving cessation and showed no association between falls and driving performance or behavior.
Falls in older adults appear to be a risk marker for subsequent MVCs and MVC-related injury. Given the nature of the evidence, which is limited to observational studies, the identified associations may also result at least partly from confounding or bias. Further research is needed to clarify the mechanisms linking falls to crash risk and to develop effective interventions to ensure driving safety in older adults with a history of falls.
研究跌倒与随后发生的机动车碰撞事故（MVC）、碰撞相关损伤、驾驶性能和驾驶行为之间的关联。
系统评价和荟萃分析。
观察性研究，包括年龄在55岁及以上或平均年龄在65岁及以上的驾驶员。
两位作者独立提取研究和参与者特征、暴露因素和结局，并评估偏倚风险。使用随机效应模型计算MVC和MVC相关损伤的合并风险估计值。其他结果进行叙述性综合。
从3286条潜在符合条件的记录中，15项研究（N = 27 - 17349名受试者）符合纳入标准。除横断面研究（n = 3）外，偏倚风险为低到中度，横断面研究均有较高的偏倚可能性。跌倒史与随后发生MVC的风险显著增加相关（汇总风险估计值 = 1.40，95%置信区间（CI）= 1.20 - 1.63；I² = 28%，N = 5项研究）。一项研究发现跌倒后MVC相关住院和死亡风险显著增加（风险比 = 3.12，95% CI = 1.71 - 5.69）。关于跌倒与停止驾驶之间的关联证据不明确，且跌倒与驾驶性能或行为之间无关联。
老年人跌倒似乎是随后发生MVC和MVC相关损伤的风险标志物。鉴于证据的性质仅限于观察性研究，所确定的关联可能至少部分是由于混杂或偏倚导致的。需要进一步研究以阐明跌倒与碰撞风险之间的联系机制，并制定有效的干预措施以确保有跌倒史的老年人的驾驶安全。
