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¿Se caerá mi paciente?

David A Ganz1, Yeran Bao, Paul G Shekelle

  • 1Veterans Affairs Greater Los Angeles Health Care System, Los Angeles, Calif 90073, USA. dganz@mednet.ucla.edu

JAMA
|January 4, 2007
PubMed
Resumen
Este resumen es generado por máquina.

Identificar el riesgo de caídas en adultos mayores es crucial. Las caídas pasadas y el deterioro de la marcha o el equilibrio son los predictores más confiables de las caídas futuras en las personas mayores.

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Área de la Ciencia:

  • Gerontología y Medicina Geriátrica.
  • La medicina preventiva es la medicina preventiva de las enfermedades.
  • Epidemiología Clínica Epidemiología clínica.

Sus antecedentes:

  • Las intervenciones multifactoriales reducen efectivamente las tasas de caídas en adultos mayores en un 30-40%.
  • Las directrices clínicas recomiendan reservar estas intervenciones para individuos de alto riesgo.
  • La identificación precisa de los factores de riesgo de caídas es esencial para la prevención dirigida.

Objetivo del estudio:

  • Revisar sistemáticamente e identificar el valor pronóstico de varios factores de riesgo para futuras caídas en adultos mayores que viven en la comunidad.
  • Informar la práctica clínica destacando los predictores clave para la evaluación del riesgo de caídas.

Principales métodos:

  • Se realizó una búsqueda exhaustiva de la literatura en las bases de datos MEDLINE y CINAHL (1966-2004).
  • Se incluyeron estudios de cohorte prospectivos que informaron un análisis multivariado de los factores de riesgo de caídas.
  • Dos revisores independientes evaluaron la calidad del estudio y extrajeron datos en seis dominios de factores de riesgo.

Principales resultados:

  • Dieciocho estudios cumplieron con los criterios de inclusión, proporcionando análisis multivariados de los factores de riesgo de caídas.
  • Los predictores más consistentes de caídas futuras en adultos mayores fueron un historial de caídas en el último año y trastornos clínicamente detectados de la marcha o el equilibrio.
  • El deterioro visual, el uso de medicamentos, las limitaciones en las actividades de la vida diaria y el deterioro cognitivo no predijeron consistentemente las caídas; la hipotensión ortostática no fue un predictor significativo después de controlar otros factores.

Conclusiones:

  • El cribado clínico para el riesgo de caídas debe priorizar la identificación de pacientes que se han caído previamente.
  • Para aquellos sin antecedentes previos de caídas, la evaluación de la marcha y el equilibrio es el siguiente paso recomendado.
  • Los pacientes con antecedentes de caídas o deterioro de la marcha/equilibrio corren un riesgo significativamente mayor de caídas futuras.