Eost-Telling Charlotte, McNally Lucy, Yang Yang, Shi Chunhu, Norman Gill, Ahmed Saima, Poku Brenda, Money Annemarie, Hawley-Hague Helen, Todd Chris J, Shenkin Susan Deborah, Vardy Emma R L C
National Institute for Health and Care Research (NIHR), Applied Research Collaboration Greater Manchester, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Division of Nursing Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Age Ageing. 2024 Nov 28;53(12). doi: 10.1093/ageing/afae270.
Systematically review and critically appraise the evidence for the association between delirium and falls in community-dwelling adults aged ≥60 years.
We searched EMBASE, MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Evidence-Based Medicine Reviews databases in April 2023. Standard methods were used to screen, extract data, assess risk of bias (using Newcastle-Ottawa scale), provide a narrative synthesis and, where appropriate, conduct meta-analysis.
We included 8 studies, with at least 3505 unique participants. Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (risk ratio 6.66; 95% confidence interval (CI) 2.16-20.53), but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled odds ratio 2.01; 95% CI 1.52-2.66); one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns.
We found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship and establish how and why this operates bidirectionally. Studies must consider confounding factors such as dementia, frailty and comorbidity in their design, to identify potential modifying factors involved. Clinicians should be aware of the potential relationship between these common presentations.
系统回顾并严格评估60岁及以上社区居住成年人谵妄与跌倒之间关联的证据。
我们于2023年4月检索了EMBASE、MEDLINE、PsycINFO、Cochrane系统评价数据库、CINAHL和循证医学评价数据库。采用标准方法进行筛选、提取数据、评估偏倚风险（使用纽卡斯尔-渥太华量表）、进行叙述性综合分析，并在适当情况下进行荟萃分析。
我们纳入了8项研究，至少有3505名独立参与者。5项研究发现谵妄与随后跌倒之间的关联证据有限：1项校正研究显示跌倒增加（风险比6.66；95%置信区间（CI）2.16 - 20.53），但证据确定性低。4项未校正研究未发现明显影响。3项研究（其中1项有两个分别处理的亚组）发现跌倒与随后谵妄之间存在关联的一些证据：3项校正研究的荟萃分析显示谵妄增加（合并比值比2.01；95% CI 1.52 - 2.66）；1个未校正数据亚组未发现明显影响。研究中报告了跌倒次数和跌倒者数量。4项研究和1个亚组存在高偏倚风险，1项研究存在一些问题。
我们发现谵妄与跌倒之间关联的证据有限。需要更严格的方法学研究来理解这种复杂关系，并确定其双向作用的方式和原因。研究在设计时必须考虑痴呆、虚弱和合并症等混杂因素，以识别潜在的调节因素。临床医生应意识到这些常见表现之间的潜在关系。
