Benjamin Ramsis, Pinkerman Seth
University of Iowa Carver College of Medicine
More than 30% of individuals aged 65 and older experience at least one fall each year, and this rate increases to approximately 50% among those aged 85 and older. Of these, 12% to 42% sustain a musculoskeletal injury, resulting in impaired mobility, reduced ability to perform activities of daily living, dehydration, pneumonia, prolonged hospitalization, and a general decline in physical and mental health. Many of these falls, however, are preventable through the use of appropriate screening tools and targeted intervention strategies. Falls are typically multifactorial, arising not only from environmental hazards such as cluttered living spaces or medication-related changes in sensorium, but also from physiological factors including sensorimotor dysfunction, vestibular and spatiotemporal dysregulation, dysautonomia, orthostatic vasculopathy, and biomechanical abnormalities. Several validated screening tools help identify these underlying pathologies, including the Functional Reach Test, the 5-Times Sit-to-Stand Test, the Berg Balance Scale, the Single-Leg Stance Test, and the Tinetti Gait and Balance Test. The latter, also known as the Performance-Oriented Mobility Assessment (POMA), is widely used across outpatient, inpatient, and rehabilitation settings. While these assessments have been applied in older adults with conditions such as Parkinson disease, multiple sclerosis, spinal cord injury, traumatic brain injury, and stroke, their predictive accuracy for identifying individuals at risk of falling remains inconsistent. Although clinical balance tests are not a substitute for a comprehensive fall risk assessment, they provide valuable information about balance impairment in older adults. Gait speed and the Timed Up and Go test are beneficial in predicting falls among individuals with dementia who are institutionalized. In contemporary practice, particularly in the post–COVID–19 era, the Tinetti Balance Test has become one of the most effective tools for assessing postural instability and functional decline, making it a crucial component of modern fall risk evaluation.
与年轻同龄人相比，老年患者跌倒相关的发病率和死亡率更高。据估计，65岁以上的人群中每年有超过30%的人跌倒，85岁以上的人群中约有50%的人每年跌倒。跌倒的人中约有12%至42%会受伤。此外，一旦跌倒，个人再次跌倒的可能性会增加50%。在这个人群中，跌倒与行动受限、日常生活活动能力下降、髋部骨折和其他肌肉骨骼损伤、脱水、肺炎以及长期住院有关。此外，对跌倒的恐惧会损害患者的独立性和行动能力，影响整体身心健康。幸运的是，使用适当的筛查方式和预防干预措施，许多跌倒都是可以预防的。跌倒往往是多因素的，因为通常存在步态和平衡障碍。一些原因包括肌肉减少症、肌肉萎缩和失衡、生物力学不当、血压控制不佳、家庭环境以及多种药物治疗。可以通过筛查方式识别此列表中的病理情况。在许多环境中使用的一种筛查方式，如门诊初级保健、住院病房或物理治疗办公室，是Tinetti步态和平衡评估，也称为以性能为导向的移动性评估。该测试很有用，因为它可以应用于不同的患者群体，包括老年人、帕金森病或多发性硬化症患者、创伤性脑损伤患者和中风患者。该测试使用标准化评分系统评估患者的平衡和步态。
