预防老年人在居住环境和社区中跌倒的干预措施的有效性：伞式综述。
Effectiveness of fall prevention interventions in residential aged care and community settings: an umbrella review.
机构信息
Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Rd North Ryde, Sydney, NSW, 2113, Australia.
National Drug & Alcohol Research Centre, University of New South Wales, Sydney, NSW, Australia.
出版信息
BMC Geriatr. 2024 Jan 19;24(1):75. doi: 10.1186/s12877-023-04624-4.
INTRODUCTION
Preventing falls is a priority for aged care providers. Research to date has focused on fall prevention strategies in single settings (e.g., residential aged care (RAC) or community settings). However, some aged care providers deliver care, including fall prevention interventions, across RAC and community settings. We conducted an umbrella review to identify what type of fall prevention interventions had the greatest impact on falls outcomes in RAC and community settings.
METHODS
Five databases were searched for systematic reviews of falls prevention randomised control trials in older adults living in the community or RAC. Data extracted included systematic review methods, population characteristics, intervention characteristics, setting details (RAC or community), and fall-related outcomes (falls, people who have had a fall, fall-related hospitalisations, and fall-related fractures). Review quality was appraised using the Assessment of Multiple Systematic Reviews-2 tool.
RESULTS
One-hundred and six systematic reviews were included; 63 and 19 of these stratified results by community and RAC settings respectively, the remainder looked at both settings. The most common intervention types discussed in reviews included 'exercise' (61%, n = 65), 'multifactorial' (two or more intervention types delivered together) (26%, n = 28), and 'vitamin D' (18%, n = 19). In RAC and community settings, 'exercise' interventions demonstrated the most consistent reduction in falls and people who have had a fall compared to other intervention types. 'Multifactorial' interventions were also beneficial in both settings however demonstrated more consistent reduction in falls and people who fall in RAC settings compared to community settings. 'Vitamin D' interventions may be beneficial in community-dwelling populations but not in RAC settings. It was not possible to stratify fall-related hospitalisation and fall-related fracture outcomes by setting due to limited number of RAC-specific reviews (n = 3 and 0 respectively).
CONCLUSION
'Exercise' interventions may be the most appropriate falls prevention intervention for older adults in RAC and community settings as it is beneficial for multiple fall-related outcomes (falls, fall-related fractures, and people who have had a fall). Augmenting 'exercise' interventions to become 'multifactorial' interventions may also improve the incidence of falls in both settings.
简介
预防老年人跌倒一直是老年护理服务提供者的首要任务。迄今为止的研究主要集中在单一环境（如养老院或社区环境）的跌倒预防策略上。然而，一些老年护理服务提供者在养老院和社区环境中提供护理，包括预防跌倒的干预措施。我们进行了一项伞式综述，以确定哪种类型的预防跌倒干预措施对养老院和社区环境中老年人的跌倒结果影响最大。
方法
在五个数据库中搜索了关于在社区或养老院居住的老年人跌倒预防随机对照试验的系统评价。提取的数据包括系统评价方法、人群特征、干预措施特征、设置细节（养老院或社区）和与跌倒相关的结局（跌倒、跌倒过的人、跌倒相关的住院和跌倒相关的骨折）。使用评估多个系统评价-2 工具评估综述质量。
结果
共纳入 106 项系统评价；其中 63 项和 19 项分别按社区和养老院环境分层结果，其余研究均涉及这两种环境。综述中讨论最多的干预类型包括“运动”（61%，n=65）、“多因素”（两种或多种干预措施一起提供）（26%，n=28）和“维生素 D”（18%，n=19）。在养老院和社区环境中，与其他干预类型相比，“运动”干预措施在减少跌倒和跌倒过的人方面最一致。“多因素”干预措施在两种环境中也是有益的，但在养老院环境中比在社区环境中更一致地减少跌倒和跌倒过的人。“维生素 D”干预措施可能对社区居住的人群有益，但对养老院环境无益。由于养老院特定的综述数量有限（n=3 和 0），因此无法按环境分层跌倒相关住院和跌倒相关骨折结局。
结论
“运动”干预措施可能是养老院和社区环境中老年人最适合的预防跌倒干预措施，因为它对多种与跌倒相关的结局（跌倒、跌倒相关骨折和跌倒过的人）有益。将“运动”干预措施增强为“多因素”干预措施也可能改善两种环境中的跌倒发生率。
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