GHU AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Pharmacie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
GHU AP-HP.Sorbonne Université, Hôpital Saint-Antoine, Pharmacie, Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France; Université Paris-Saclay, Faculté de Pharmacie, Département de Pharmacie Clinique, Chatenay Malabry, France.
J Am Med Dir Assoc. 2020 Oct;21(10):1451-1457.e6. doi: 10.1016/j.jamda.2020.04.025. Epub 2020 Jul 12.
Falls are an important issue in older adults as they are frequent, deleterious, and often lead to repeated consultations at the emergency department (ED) and unplanned hospitalizations. Our principal objective was to provide an inventory of interventions designed to prevent unplanned readmissions or ED visits of older patients presenting to hospital with a fall.
Systematic review performed on February 11, 2019 in MEDLINE via PubMed, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science, without date or language restriction. We manually updated this search in August 1, 2019. Study selection, data extraction and risk of bias assessment were conducted independently by 2 reviewers.
We included studies reporting interventions to prevent unplanned readmissions or ED visits of older patients (aged 65 years or over) presenting to hospital because of a fall.
We identified 475 unique citations after removing duplicates and included 6 studies (2 observational and 4 interventional studies). The studies were published between 2012 and 2019; they evaluated heterogeneous interventions that were frequently multifaceted and multidisciplinary. The interventions were shown effective in reducing readmissions or ED revisits compared with control groups in 3 studies (relative risk reductions between 30% and 65%), all of which were multifaceted and 2/3 multidisciplinary.
With 6 articles showing inconsistent results, our study highlights the need to adequately design and evaluate interventions to reduce the burden of hospital readmissions among older fallers. Retrieved studies are recent, which underlines that hospital readmissions are a current concern for researchers and public health authorities [PROSPERO registration number: CRD42019131965].
老年人经常发生跌倒，且跌倒危害大，常常导致他们反复到急诊科（ED）就诊和计划外住院。我们的主要目的是提供一份干预措施清单，以预防因跌倒而到医院就诊的老年患者发生计划外再入院或 ED 就诊。
2019 年 2 月 11 日，我们通过 MEDLINE 下的 PubMed、EMBASE、Cochrane 对照试验中心注册库和 Web of Science 进行了系统评价，无日期或语言限制。2019 年 8 月 1 日，我们手动更新了该搜索。两名评审员独立进行了研究选择、数据提取和偏倚风险评估。
我们纳入了报告干预措施以预防因跌倒而到医院就诊的老年患者（年龄≥65 岁）发生计划外再入院或 ED 就诊的研究。
在去除重复项后，我们共识别出 475 条独特的引文，并纳入了 6 项研究（2 项观察性研究和 4 项干预性研究）。这些研究发表于 2012 年至 2019 年期间；它们评估了各种不同的干预措施，这些干预措施通常是多方面和多学科的。在 3 项研究中，与对照组相比，干预措施显示可有效降低再入院或 ED 复诊率（相对风险降低幅度为 30%至 65%），所有这些研究均为多方面的，2/3 项为多学科的。
有 6 项研究结果不一致，这突出表明需要充分设计和评估干预措施，以减少老年跌倒患者的医院再入院负担。纳入的研究均为近期研究，这强调了医院再入院是研究人员和公共卫生当局当前关注的问题[PROSPERO 注册号：CRD42019131965]。
