Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada.
Division of Geriatric Medicine, Department of Medicine, Schulich School of Medicine & Dentistry, University of Western Ontario, London, ON, Canada.
Age Ageing. 2022 Sep 2;51(9). doi: 10.1093/ageing/afac205.
BACKGROUND: falls and fall-related injuries are common in older adults, have negative effects on functional independence and quality of life and are associated with increased morbidity, mortality and health related costs. Current guidelines are inconsistent, with no up-to-date, globally applicable ones present. OBJECTIVES: to create a set of evidence- and expert consensus-based falls prevention and management recommendations applicable to older adults for use by healthcare and other professionals that consider: (i) a person-centred approach that includes the perspectives of older adults with lived experience, caregivers and other stakeholders; (ii) gaps in previous guidelines; (iii) recent developments in e-health and (iv) implementation across locations with limited access to resources such as low- and middle-income countries. METHODS: a steering committee and a worldwide multidisciplinary group of experts and stakeholders, including older adults, were assembled. Geriatrics and gerontological societies were represented. Using a modified Delphi process, recommendations from 11 topic-specific working groups (WGs), 10 ad-hoc WGs and a WG dealing with the perspectives of older adults were reviewed and refined. The final recommendations were determined by voting. RECOMMENDATIONS: all older adults should be advised on falls prevention and physical activity. Opportunistic case finding for falls risk is recommended for community-dwelling older adults. Those considered at high risk should be offered a comprehensive multifactorial falls risk assessment with a view to co-design and implement personalised multidomain interventions. Other recommendations cover details of assessment and intervention components and combinations, and recommendations for specific settings and populations. CONCLUSIONS: the core set of recommendations provided will require flexible implementation strategies that consider both local context and resources.
背景:老年人中跌倒和与跌倒相关的伤害很常见,对其功能独立性和生活质量有负面影响,且与发病率、死亡率和健康相关成本增加有关。目前的指南不一致,没有最新的、全球适用的指南。
目的:制定一套基于证据和专家共识的适用于老年人的跌倒预防和管理建议,供医疗保健和其他专业人员使用,这些建议考虑了:(i)以人为主导的方法,包括有生活经验的老年人、照顾者和其他利益相关者的观点;(ii)以前指南中的差距;(iii)电子健康方面的最新进展;(iv)在资源有限的情况下(如中低收入国家)在各地的实施情况。
方法:成立了一个指导委员会和一个由全球多学科专家和利益相关者组成的小组,其中包括老年人。代表了老年医学和老年学学会。使用改良 Delphi 过程,对来自 11 个专题工作组(WG)、10 个特设工作组和一个处理老年人观点的工作组的建议进行了审查和完善。最终建议通过投票确定。
建议:应向所有老年人提供预防跌倒和进行身体活动的建议。建议对社区居住的老年人进行跌倒风险的机会性筛查。对于被认为风险较高的人,应提供全面的多因素跌倒风险评估,以期共同设计和实施个性化的多领域干预措施。其他建议涵盖了评估和干预措施的详细内容和组合,以及针对特定环境和人群的建议。
结论:所提供的核心建议需要灵活的实施策略,既要考虑当地情况,又要考虑资源情况。
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