Brown University Warren Alpert Medical School, Providence, Rhode Island, USA
Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Inj Prev. 2024 Nov 21;30(6):446-453. doi: 10.1136/ip-2023-045110.
Falls are a leading cause of morbidity and mortality among older adults in the USA. Current approaches to fall prevention often rely on referral by primary care providers or enrolment during inpatient admissions. Community emergency medical services (CEMS) present a unique opportunity to rapidly identify older adults at risk for falls and provide fall prevention interventions in the home. In this systematic review, we seek to assess the efficacy and qualitative factors determining success of these programs.
Studies reporting the outcomes of fall prevention interventions delivered by EMS were identified by searching the electronic databases PubMed, Embase, Web of Science Core Collection, CINAHL and the Cochrane Central Register of Controlled Trials through 11 July 2023.
35 studies including randomised and non-randomised experimental trials, systematic reviews and qualitative research primarily from Western Europe, the USA, Australia and Canada were included in our analysis. Current fall prevention efforts focus heavily on postfall referral of at-risk community members. CEMS fall prevention interventions reduced all-cause and fall-related emergency department encounters, subsequent falls and EMS calls for lift assist. These interventions also improved patient health-related quality of life, independence with activities of daily living, and secondary health outcomes.
CEMS programmes provide an opportunity for direct, proactive fall prevention on the individual level. Addressing barriers to implementation in the context of current emergency medical systems in the USA is the next step toward widespread implementation of these novel fall prevention interventions.
在美国，老年人的跌倒发生率高，是发病率和死亡率的主要原因之一。目前的跌倒预防方法通常依赖于初级保健提供者的转诊或住院期间的登记。社区紧急医疗服务（CEMS）提供了一个独特的机会，可以快速识别有跌倒风险的老年人，并在家庭中提供跌倒预防干预措施。在本次系统评价中，我们旨在评估这些计划的效果和决定成功的定性因素。
通过搜索电子数据库 PubMed、Embase、Web of Science Core Collection、CINAHL 和 Cochrane 对照试验中心注册，于 2023 年 7 月 11 日之前确定了报告由 EMS 提供的跌倒预防干预措施结果的研究。
我们的分析包括了 35 项研究，这些研究主要来自西欧、美国、澳大利亚和加拿大，包括随机和非随机实验性试验、系统评价和定性研究。目前的跌倒预防工作主要集中在对有风险的社区成员进行跌倒后的转诊。CEMS 跌倒预防干预措施降低了全因和与跌倒相关的急诊科就诊、随后的跌倒和 EMS 呼叫以提供升力辅助。这些干预措施还改善了患者的健康相关生活质量、日常生活活动的独立性以及次要健康结果。
CEMS 计划为个体层面的直接、主动的跌倒预防提供了机会。在美国，针对当前紧急医疗系统实施障碍的解决是广泛实施这些新型跌倒预防干预措施的下一步。
