Aging, Mobility and Cognitive Neuroscience Laboratory, Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Djavad Mowafaghian Centre for Brain Health, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada.
Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada; Social & Economic Change Laboratory, Faculty of Management, University of British Columbia-Okanagan Campus, Kelowna, British Columbia, Canada.
Maturitas. 2021 Feb;144:23-28. doi: 10.1016/j.maturitas.2020.10.021. Epub 2020 Nov 2.
Older adults who fall recurrently (i.e., 2 or more falls/year) are at risk of functional decline and mortality. Understanding which risk factors for recurrent falls are most important will inform secondary fall prevention strategies that can reduce recurrent falls risk. Thus, we conducted a systematic review with meta-analysis to determine the relative risk of recurrent falls for different types of falls risk factors. MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched on April 25, 2019 (Prospero Registration: CRD42019118888). We included peer-reviewed prospective studies which examined risk factors that contributed to recurrent falls in adults aged ≥ 60 years. Using the falls risk classification system of Lord and colleagues, we classified each risk factor into one of the following domains: 1) balance and mobility; 2) environmental; 3) psychological; 4) medical; 5) medication; 6) sensory and neuromuscular; or 7) sociodemographic. We calculated the summary relative risk (RR) for each domain and evaluated the risk of bias and quality of reporting. Twenty-two studies were included in this systematic review and meta-analysis. Four domains predicted recurrent falls: balance and mobility (RR:1.32;95 % CI:[1.10, 1.59]), medication (RR:1.53;95 % CI:[1.11, 2.10]), psychological (RR:1.35;95 % CI:[1.03, 1.78]), and sensory and neuromuscular (RR:1.51;95 % CI:[1.18, 1.92]). Each of these four domains can be viewed as a marker of frailty. The risk of bias was low, and the study quality was high (minimum:19/22). Older adults with markers of frailty are up to 53 % more likely to experience recurrent falls. Strategies that identify and resolve frailty markers should be a frontline approach to preventing recurrent falls.
经常跌倒（即每年 2 次或以上跌倒）的老年人有出现功能下降和死亡的风险。了解哪些复发性跌倒的风险因素最重要，将有助于制定二级跌倒预防策略，以降低复发性跌倒的风险。因此，我们进行了一项系统评价和荟萃分析，以确定不同类型跌倒风险因素与复发性跌倒的相对风险。我们于 2019 年 4 月 25 日检索了 MEDLINE、EMBASE、PsycINFO 和 CINAHL 数据库（PROSPERO 注册号：CRD42019118888）。我们纳入了同行评议的前瞻性研究，这些研究检查了导致 60 岁及以上成年人复发性跌倒的风险因素。我们使用 Lord 及其同事的跌倒风险分类系统，将每个风险因素归入以下一个或多个类别：1）平衡和移动能力；2）环境；3）心理；4）医学；5）药物；6）感官和神经肌肉；或 7）社会人口统计学。我们计算了每个类别下的汇总相对风险（RR），并评估了偏倚风险和报告质量。本系统评价和荟萃分析共纳入了 22 项研究。有四个类别可以预测复发性跌倒：平衡和移动能力（RR：1.32；95 % CI：[1.10, 1.59]）、药物（RR：1.53；95 % CI：[1.11, 2.10]）、心理（RR：1.35；95 % CI：[1.03, 1.78]）和感官及神经肌肉（RR：1.51；95 % CI：[1.18, 1.92]）。这四个类别中的每一个都可以被视为脆弱的标志。偏倚风险较低，研究质量较高（最低分为 19/22）。有脆弱标志物的老年人发生复发性跌倒的可能性增加了 53 %。识别和解决脆弱标志物的策略应该成为预防复发性跌倒的首选方法。
