Falls and Balance Research Group, Neuroscience Research Australia, Randwick, NSW, Australia; School of Medical Sciences, University of New South Wales, Sydney, Australia.
Falls and Balance Research Group, Neuroscience Research Australia, Randwick, NSW, Australia; School of Population Health, University of New South Wales, Sydney, Australia.
Ageing Res Rev. 2021 Nov;71:101452. doi: 10.1016/j.arr.2021.101452. Epub 2021 Aug 25.
This systematic review aimed to identify risk factors for prospectively ascertained falls, focusing on those that are potentially modifiable (physical and neuropsychological factors), in older people with cognitive impairment living in the community.
A comprehensive search of five databases identified 16 high quality (Newcastle-Ottawa Scale ≥8/9) relevant articles. Meta-analyses were undertaken for five potential fall risk factors. Of these, fallers had significantly poorer balance (standardized mean difference = 0.62, 95 %CI 0.45, 0.79) with low heterogeneity. Global cognition was not significantly associated with faller status in a meta-analysis with low heterogeneity. Meta-analyses of mobility (Timed Up-and-Go), gait speed and depressive symptoms had high heterogeneity and were not statistically significant or were borderline significant (p = 0.05). Sensitivity analyses (removing one study sample's results that differed markedly from the other included samples) reduced heterogeneity to 0% and revealed fallers had significantly poorer mobility and more depressive symptoms than non-fallers. Fallers also walked significantly slower, but heterogeneity remained high.
In older people with cognitive impairment, fallers presented with balance deficits, poor mobility, slow gait speed and depressive symptoms. Reduced global cognition was not associated with falls. These findings suggest that interventions should target balance impairment and reveal that more high-quality research is needed.
本系统评价旨在确定认知障碍的社区居住老年人前瞻性跌倒的风险因素，重点关注那些潜在可改变的（身体和神经心理学因素）。
对五个数据库进行全面检索，确定了 16 篇高质量（纽卡斯尔-渥太华量表≥8/9）的相关文章。对五个潜在跌倒风险因素进行了荟萃分析。其中，跌倒者的平衡能力明显较差（标准化均数差=0.62，95%CI 0.45，0.79），异质性较低。在一项异质性较低的荟萃分析中，总体认知与跌倒者状态无显著相关性。对移动性（计时起立行走）、步态速度和抑郁症状的荟萃分析具有较高的异质性，且无统计学意义或边缘显著（p=0.05）。敏感性分析（去除一个研究样本的结果与其他纳入样本明显不同）将异质性降低至 0%，结果显示跌倒者的移动性和抑郁症状明显较差，而步态速度较慢，但异质性仍然很高。
在认知障碍的老年人中，跌倒者表现出平衡障碍、移动性差、步态速度慢和抑郁症状。总体认知能力降低与跌倒无关。这些发现表明，干预措施应针对平衡障碍，且需要更多高质量的研究。
