School of Nursing, Sun Yat-sen University, Guangzhou, China.
Nursing Department, Home for the Aged Guangzhou, Guangzhou, China.
J Am Med Dir Assoc. 2023 Nov;24(11):1708-1717. doi: 10.1016/j.jamda.2023.06.002. Epub 2023 Jul 8.
Falls are common among older people in nursing homes, and the assessment of fall risk factors is critical for the success of fall prevention interventions. This study aimed to systematically assess the incidence and risk factors of falls in older people living in nursing homes.
Systematic review and meta-analysis.
Older people living in nursing homes.
Literature searches were conducted independently by 2 researchers in 8 databases. Qualities of included studies were assessed using the Newcastle-Ottawa Scale. The prevalence and risk factors of falls were analyzed with a random effects model. All analyses were performed by R software, x64 4.2.2.
In 18 prospective studies addressing older adults living in nursing homes, the pooled incidence of falls was 43% (95% CI 38%-49%), and the meta-regression analysis indicated that the incidence generally decreased from 1998 to 2021. The following risk factors had a strong association with all falls: fall history, impaired ADL performance, insomnia, and depression. Risk factors with low to moderate correlation were vertigo, walking aids, poor balance, use of antidepressants, use of benzodiazepines, use of antipsychotics, use of anxiolytics, polypharmacy, dementia, unsteady gait, hearing problems, and gender (being male). Having bed rails was identified as a protective environmental factor.
The results from our meta-analysis suggest that the incidence of falls of older adults living in nursing homes is high, and the risk factors for falls are various. Assessments of balance and mobility, medical condition, and use of medications should be included as key elements in the fall risk assessments of older people in nursing homes. Environmental risk factors still need to be explored in future studies. Tailored fall prevention strategies should be implemented by addressing the modifiable risk factors.
养老院中的老年人经常发生跌倒，评估跌倒风险因素对于预防跌倒干预措施的成功至关重要。本研究旨在系统评估居住在养老院中的老年人跌倒的发生率和风险因素。
系统评价和荟萃分析。
居住在养老院中的老年人。
两名研究人员独立在 8 个数据库中进行文献检索。使用纽卡斯尔-渥太华量表评估纳入研究的质量。使用随机效应模型分析跌倒的发生率和风险因素。所有分析均使用 R 软件（x64 4.2.2）进行。
在 18 项针对居住在养老院中的老年人的前瞻性研究中，跌倒的总发生率为 43%（95%CI 38%-49%），荟萃回归分析表明发生率总体上从 1998 年到 2021 年呈下降趋势。与所有跌倒有强烈关联的风险因素包括：跌倒史、ADL 功能受损、失眠和抑郁。与跌倒有低到中度相关性的风险因素包括：眩晕、使用助行器、平衡能力差、使用抗抑郁药、使用苯二氮䓬类药物、使用抗精神病药、使用抗焦虑药、多种药物治疗、痴呆、步态不稳、听力问题和性别（男性）。有床栏被认为是一种保护性环境因素。
我们的荟萃分析结果表明，居住在养老院中的老年人跌倒的发生率较高，跌倒的风险因素多种多样。评估平衡和移动能力、医疗状况和用药情况应作为养老院中老年人跌倒风险评估的关键要素。未来的研究仍需探索环境风险因素。应通过针对可改变的风险因素实施有针对性的跌倒预防策略。
