Oregon Research Institute, Eugene, OR 97403, USA.
Shanghai University of Sport, Shanghai, China.
Age Ageing. 2021 Sep 11;50(5):1557-1568. doi: 10.1093/ageing/afab110.
Exercise prevents falls in the general older population, but evidence is inconclusive for older adults living with cognitive impairment. We performed an updated systematic review and meta-analysis to assess the potential effectiveness of interventions for reducing falls in older persons with cognitive impairment.
PubMed, EMBASE, CINAHL, Scopus, CENTRAL and PEDro were searched from inception to 10 November 2020. We included randomised controlled trials (RCTs) that evaluated the effects of physical training compared to a control condition (usual care, waitlist, education, placebo control) on reducing falls among community-dwelling older adults with cognitive impairment (i.e. any stage of Alzheimer's disease and related dementias, mild cognitive impairment).
We identified and meta-analysed nine studies, published between 2013 and 2020, that included 12 comparisons (N = 1,411; mean age = 78 years; 56% women). Overall, in comparison to control, interventions produced a statistically significant reduction of approximately 30% in the rate of falls (incidence rate ratio = 0.70; 95% CI, 0.52-0.95). There was significant between-trial heterogeneity (I2 = 74%), with most trials (n = 6 studies [eight comparisons]) showing no reductions on fall rates. Subgroup analyses showed no differences in the fall rates by trial-level characteristics. Exercise-based interventions had no impact on reducing the number of fallers (relative risk = 1.01; 95% CI, 0.90-1.14). Concerns about risk of bias in these RCTs were noted, and the quality of evidence was rated as low.
The positive statistical findings on reducing fall rate in this meta-analysis were driven by a few studies. Therefore, current evidence is insufficient to inform evidence-based recommendations or treatment decisions for clinical practice.PROSPERO Registration number: CRD42020202094.
运动可预防普通老年人群的跌倒，但对于认知障碍的老年人群，证据尚不确定。我们进行了一项更新的系统评价和荟萃分析，以评估干预措施减少认知障碍老年人跌倒的潜在效果。
从建库到 2020 年 11 月 10 日，我们在 PubMed、EMBASE、CINAHL、Scopus、CENTRAL 和 PEDro 中进行了检索。我们纳入了随机对照试验（RCT），这些试验评估了与对照条件（常规护理、候补名单、教育、安慰剂对照）相比，身体训练对减少认知障碍的社区居住老年人（即任何阶段的阿尔茨海默病和相关痴呆症、轻度认知障碍）跌倒的影响。
我们确定并荟萃分析了 9 项研究，这些研究发表于 2013 年至 2020 年之间，共包括 12 项比较（N=1411；平均年龄=78 岁；56%为女性）。总体而言，与对照组相比，干预措施使跌倒率降低了约 30%（发生率比=0.70；95%CI，0.52-0.95）。存在显著的试验间异质性（I2=74%），大多数试验（n=6 项研究[8 项比较]）显示跌倒率没有降低。亚组分析显示，试验水平特征对跌倒率没有差异。基于运动的干预措施对减少跌倒者人数没有影响（相对风险=1.01；95%CI，0.90-1.14）。注意到这些 RCT 存在偏倚风险的担忧，证据质量被评为低。
荟萃分析中关于降低跌倒率的阳性统计结果是由少数研究驱动的。因此，目前的证据不足以为临床实践提供循证建议或治疗决策。PROSPERO 注册号：CRD42020202094。
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