George Washington University, Washington, DC.
Brown University, Providence, Rhode Island.
JAMA. 2024 Jul 2;332(1):51-57. doi: 10.1001/jama.2024.8481.
Falls are the leading cause of injury-related morbidity and mortality among older adults in the US. In 2018, 27.5% of community-dwelling adults 65 years or older reported at least 1 fall in the past year and 10.2% reported a fall-related injury. In 2021, an estimated 38 742 deaths resulted from fall-related injuries.
The US Preventive Services Task Force (USPSTF) commissioned a systematic review to evaluate the effectiveness and harms of primary care-relevant interventions to prevent falls and fall-related morbidity and mortality in community-dwelling adults 65 years or older.
Community-dwelling adults 65 years or older at increased risk of falls.
The USPSTF concludes with moderate certainty that exercise interventions provide a moderate net benefit in preventing falls and fall-related morbidity in older adults at increased risk for falls. The USPSTF concludes with moderate certainty that multifactorial interventions provide a small net benefit in preventing falls and fall-related morbidity in older adults at increased risk for falls.
The USPSTF recommends exercise interventions to prevent falls in community-dwelling adults 65 years or older who are at increased risk for falls. (B recommendation) The USPSTF recommends that clinicians individualize the decision to offer multifactorial interventions to prevent falls to community-dwelling adults 65 years or older who are at increased risk for falls. Existing evidence indicates that the overall net benefit of routinely offering multifactorial interventions to prevent falls is small. When determining whether this service is appropriate for an individual, patients and clinicians should consider the balance of benefits and harms based on the circumstances of prior falls, presence of comorbid medical conditions, and the patient's values and preferences. (C recommendation).
在美国，老年人因跌倒导致受伤而出现发病和死亡的比例较高。2018 年，有 27.5%的 65 岁及以上社区居住成年人报告在过去一年中至少跌倒过一次，10.2%报告因跌倒而受伤。2021 年，估计有 38742 人因跌倒相关伤害而死亡。
美国预防服务工作组（USPSTF）委托进行了一项系统评价，以评估初级保健相关干预措施在预防 65 岁及以上社区居住成年人跌倒及与跌倒相关的发病和死亡方面的有效性和危害。
有跌倒风险增加的 65 岁及以上社区居住成年人。
USPSTF 得出结论，有中度确定性，运动干预措施可适度预防跌倒和与跌倒相关的发病，对有跌倒风险增加的老年人有中度净获益。USPSTF 得出结论，多因素干预措施适度预防跌倒和与跌倒相关的发病，对有跌倒风险增加的老年人有小的净获益。
USPSTF 建议对有跌倒风险增加的 65 岁及以上社区居住成年人进行运动干预以预防跌倒。（B 级推荐）USPSTF 建议临床医生根据增加跌倒风险的社区居住成年人的具体情况，个体化决定是否提供多因素干预措施以预防跌倒。现有的证据表明，常规提供多因素干预措施以预防跌倒的总体净获益较小。在确定是否为个体提供该服务时，患者和临床医生应根据既往跌倒情况、并存的医疗状况以及患者的价值观和偏好，权衡利弊。（C 级推荐）。
