Schoberer Daniela, Breimaier Helga Elisabeth, Zuschnegg Julia, Findling Thomas, Schaffer Susanna, Archan Tamara
Institute of Nursing Science, Medical University Graz, Graz, Austria.
Strategic Management of Nursing, RKU - University and Rehabilitation Clinics Ulm, Ulm, Germany.
Worldviews Evid Based Nurs. 2022 Apr;19(2):86-93. doi: 10.1111/wvn.12571. Epub 2022 Mar 9.
Falls and their consequences are particularly common in older adults in hospitals and long-term care (LTC) facilities.
To avoid falls and their consequences, and provide nurses with an overview of all relevant research literature on fall prevention, and a practice guideline on fall prevention in older adults was developed.
The development process included a systematic literature review to identify systematic reviews and primary studies on the topic of fall prevention, an assessment of the study quality, the preparation of meta-analyses to summarize the results, and the application of the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach to grade the scientific literature. The guideline panel and an external multidisciplinary team graded the recommendations using the Delphi method. In addition, the panel and team formulated expert opinions.
A total of 79 randomized controlled trials on fall prevention were identified, which formed the basis of the recommendations. Strongly recommended measures for both settings included multifactorial interventions, professionally supported body exercise interventions, and education and counselling interventions. The panel and team did not recommend the use of a specific assessment tool for fall risk assessment, low-floor beds in hospitals, or body exercise interventions in frail residents.
During the development of this guideline, particular attention was paid to collecting evidence-based knowledge relevant to practice. By applying the recommendations, the outlined nursing care is justified, enabling healthcare personnel to achieve the overriding goal of providing optimal care to persons at risk of falling. Evidence for several fall prevention interventions was graded as very low. Sound intervention studies are necessary to strengthen the confidence in the evidence for low-floor beds, alarm sensor systems, medication review, and staff education in hospitals.
跌倒及其后果在医院和长期护理（LTC）机构的老年人中尤为常见。
为避免跌倒及其后果，为护士提供有关预防跌倒的所有相关研究文献综述，并制定老年人预防跌倒的实践指南。
制定过程包括系统的文献综述，以识别关于预防跌倒主题的系统评价和原始研究，评估研究质量，准备荟萃分析以总结结果，以及应用GRADE（推荐分级评估、制定和评价）方法对科学文献进行分级。指南小组和外部多学科团队使用德尔菲法对建议进行分级。此外，该小组和团队还制定了专家意见。
共确定了79项关于预防跌倒的随机对照试验，这些试验构成了建议的基础。两种环境下强烈推荐的措施包括多因素干预、专业支持的身体锻炼干预以及教育和咨询干预。该小组和团队不建议使用特定的评估工具进行跌倒风险评估、医院的低地板床或体弱居民的身体锻炼干预。
在本指南的制定过程中，特别关注收集与实践相关的循证知识。通过应用这些建议，所概述的护理措施是合理的，使医护人员能够实现为有跌倒风险的人提供最佳护理这一首要目标。几种预防跌倒干预措施的证据等级被评为非常低。需要进行可靠的干预研究，以增强对医院低地板床、警报传感器系统、药物审查和员工教育证据的信心。
