Ellmers Toby Jack, Ventre Jodi P, Freiberger Ellen, Hauer Klaus, Hogan David B, Lim Mei Ling, McGarrigle Lisa, Nyman Samuel Robert, Todd Chris J, Li Yuxiao, Delbaere Kim
Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, UK.
National Institute for Health and Care Research, Applied Research Collaboration- Greater Manchester & School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.
Age Ageing. 2025 Mar 28;54(4). doi: 10.1093/ageing/afaf089.
The 2022 World Falls Guidelines recommend assessing concerns (or 'fears') about falling in multifactorial fall risk assessments. However, the evidence base for this recommendation is limited. This review evaluated the evidence for concerns about falling as an independent predictor of future falls, applying the Bradford Hill criteria for causality.
Systematic review and meta-analyses were conducted (PROSPERO registration ID: CRD42023387212). MEDLINE, CINAHL Plus, Web of Science and PsycINFO were searched for studies examining associations between baseline concerns about falling and future falls in older adults (minimum 6-month follow-up). Meta-analyses examined associations between concerns about falling and future falls. Risk of bias was assessed using an adapted Newcastle Ottawa Scale for cohort studies, and evidence certainty was rated with GRADE.
About 53 studies, comprising 75,076 participants, were included. Meta-analysis showed significant independent association between baseline concerns and future falls when using the Falls Efficacy Scale-International to assess concerns (full scale version, pooled OR = 1.03 [95% CI = 1.02-1.05] per 1-point increase; short scale version, pooled OR = 1.08 [95% CI = 1.05-1.11]). Significant associations were also observed when using single-item measures of concerns (pooled OR = 1.60 [95% CI = 1.36-1.89] for high vs. low concerns). In contrast, balance confidence (Activities-Specific Balance Confidence Scale) did not predict future falls (pooled OR = 0.97 [95% CI = 0.93-1.01]). Despite 26 studies rated as poor quality, associations were consistent across studies of different quality. The overall certainty of the evidence was rated as moderate.
Baseline concern about falling is a clear predictor of future falls in older adults, supporting its inclusion in fall risk assessments. Regular assessment of concerns about falling, along with targeted interventions, could help reduce the risk of falls in older adults.
《2022年世界跌倒指南》建议在多因素跌倒风险评估中评估对跌倒的担忧（或“恐惧”）。然而，这一建议的证据基础有限。本综述应用布拉德福德·希尔因果关系标准，评估了对跌倒的担忧作为未来跌倒独立预测因素的证据。
进行了系统综述和荟萃分析（PROSPERO注册编号：CRD42023387212）。检索了MEDLINE、CINAHL Plus、科学网和PsycINFO数据库，以查找研究老年人基线跌倒担忧与未来跌倒之间关联的研究（最短随访6个月）。荟萃分析检验了跌倒担忧与未来跌倒之间的关联。使用适用于队列研究的纽卡斯尔-渥太华量表评估偏倚风险，并采用GRADE对证据确定性进行评级。
纳入了约53项研究，共75076名参与者。荟萃分析显示，使用国际跌倒效能量表评估担忧时，基线担忧与未来跌倒之间存在显著的独立关联（全量表版本，每增加1分，合并OR = 1.03 [95% CI = 1.02 - 1.05]；短量表版本，合并OR = 1.08 [95% CI = 1.05 - 1.11]）。使用单项担忧测量时也观察到显著关联（高担忧与低担忧相比，合并OR = 1.60 [95% CI = 1.36 - 1.89]）。相比之下，平衡信心（特定活动平衡信心量表）不能预测未来跌倒（合并OR = 0.97 [95% CI = 0.93 - 1.01]）。尽管26项研究质量被评为较差，但不同质量研究的关联结果一致。证据的总体确定性被评为中等。
基线跌倒担忧是老年人未来跌倒的明确预测因素，支持将其纳入跌倒风险评估。定期评估跌倒担忧并进行有针对性的干预，有助于降低老年人跌倒风险。
