Kaiser Permanente Research Affiliates Evidence-based Practice Center, Center for Health Research, Kaiser Permanente, Portland, Oregon.
Department of Family Medicine, University of Washington, Tacoma.
JAMA. 2018 Apr 24;319(16):1705-1716. doi: 10.1001/jama.2017.21962.
Falls are the most common cause of injury-related morbidity and mortality among older adults.
To systematically review literature on the effectiveness and harms of fall prevention interventions in community-dwelling older adults to inform the US Preventive Services Task Force.
MEDLINE, PubMed, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Trials for relevant English-language literature published through August 2016, with ongoing surveillance through February 7, 2018.
Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years and older.
Independent critical appraisal and data abstraction by 2 reviewers. Random-effects meta-analyses using the method of DerSimonian and Laird.
Number of falls (number of unexpected events in which a person comes to rest on the ground, floor, or lower level), people experiencing 1 or more falls, injurious falls, people experiencing injurious falls, fractures, people experiencing fractures, mortality, hospitalizations, institutionalizations, changes in disability, and treatment harms.
Sixty-two randomized clinical trials (N = 35 058) examining 7 fall prevention intervention types were identified. This article focused on the 3 most commonly studied intervention types: multifactorial (customized interventions based on initial comprehensive individualized falls risk assessment) (26 trials [n = 15 506]), exercise (21 trials [n = 7297]), and vitamin D supplementation (7 trials [n = 7531]). Multifactorial intervention trials were associated with a reduction in falls (incidence rate ratio [IRR], 0.79 [95% CI, 0.68-0.91]) but were not associated with a reduction in other fall-related morbidity and mortality outcomes. Exercise trials were associated with statistically significant reductions in people experiencing a fall (relative risk, 0.89 [95% 13 CI, 0.81-0.97]) and injurious falls (IRR, 0.81 [95% CI, 0.73-0.90]) and with a statistically nonsignificant reduction in falls (IRR, 0.87 [95% CI, 0.75-1.00]) but showed no association with mortality. Few exercise trials reported fall-related fractures. Seven heterogeneous trials of vitamin D formulations (with or without calcium) showed mixed results. One trial of annual high-dose cholecalciferol (500 000 IU), which has not been replicated, showed an increase in falls, people experiencing a fall, and injuries, while 1 trial of calcitriol showed a reduction in falls and people experiencing a fall; the remaining 5 trials showed no significant difference in falls, people experiencing a fall, or injuries. Harms of multifactorial and exercise trials were rarely reported but generally included minor musculoskeletal injuries.
Multifactorial and exercise interventions were associated with fall-related benefit, but evidence was most consistent across multiple fall-related outcomes for exercise. Vitamin D supplementation interventions had mixed results, with a high dose being associated with higher rates of fall-related outcomes.
跌倒 是老年人中与伤害相关发病率和死亡率的最常见原因。
系统回顾社区居住的老年人中预防跌倒干预措施的有效性和危害，为美国预防服务工作组提供信息。
截至 2016 年 8 月发表的相关英文文献的 MEDLINE、PubMed、Cumulative Index for Nursing and Allied Health Literature 和 Cochrane 对照试验中心注册库，通过 2018 年 2 月 7 日的持续监测。
预防跌倒的干预措施，在 65 岁及以上的社区居住的成年人中。
两名独立的关键评估和数据提取员。使用 DerSimonian 和 Laird 的方法进行随机效应荟萃分析。
跌倒次数（意外事件中，人倒在地面、地板或较低水平的次数），发生 1 次或多次跌倒的人数，伤害性跌倒，发生伤害性跌倒的人数，骨折，发生骨折的人数，死亡率，住院治疗，住院治疗，残疾变化，以及治疗危害。
确定了 62 项随机临床试验（N = 35058），研究了 7 种预防跌倒的干预措施。本文重点研究了 3 种最常见的干预措施：多因素（根据最初的全面个体化跌倒风险评估定制的干预措施）（26 项试验 [n = 15506]）、运动（21 项试验 [n = 7297]）和维生素 D 补充剂（7 项试验 [n = 7531]）。多因素干预试验与跌倒减少相关（发病率比 [IRR]，0.79 [95% CI，0.68-0.91]），但与其他与跌倒相关的发病率和死亡率结果无关。运动试验与跌倒（相对风险，0.89 [95% 13 CI，0.81-0.97]）和伤害性跌倒（IRR，0.81 [95% CI，0.73-0.90]）的发生率显著降低有关，与跌倒发生率的统计学无显著降低（IRR，0.87 [95% CI，0.75-1.00]），但与死亡率无关。很少有运动试验报告与跌倒相关的骨折。7 项不同维生素 D 配方（含或不含钙）的试验结果混杂。一项关于每年高剂量胆钙化醇（500 000 IU）的试验，尚未被复制，显示跌倒、跌倒和受伤的增加，而一项关于骨化三醇的试验显示跌倒和跌倒的减少；其余 5 项试验显示跌倒、跌倒和受伤无显著差异。多因素和运动试验的危害很少报道，但通常包括轻微的肌肉骨骼损伤。
多因素和运动干预措施与跌倒相关的益处有关，但在多个与跌倒相关的结果中，证据最为一致。维生素 D 补充剂干预措施的结果混杂，高剂量与更高的跌倒相关结果发生率相关。
