我的病人会跌倒吗?
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
概括
确定老年人中跌倒风险至关重要. 过去的跌倒和步行或平衡障碍是老年人未来跌倒的最可靠预测因素.
科学领域:
- 老年学和老年医学是老年学和老年医学.
- 预防医学 预防医学
- 临床流行病学临床流行病学
背景情况:
- 多因素干预有效地将老年人跌倒率降低了30-40%.
- 临床指南建议将这些干预措施保留给高危人群.
- 准确识别跌倒风险因素对于有针对性的预防至关重要.
研究的目的:
- 系统地审查和确定各种风险因素的预后价值,以期在社区居住的老年人中未来的跌倒.
- 通过突出跌倒风险评估的关键预测因素,为临床实践提供信息.
主要方法:
- 在MEDLINE和CINAHL (1966-2004) 数据库中进行了全面的文献搜索.
- 包含了前性队列研究,报告了跌倒风险因素的多变量分析.
- 两位独立审查员评估了研究质量,并提取了六个风险因素领域的数据.
主要成果:
- 十八项研究符合纳入标准,提供了对跌倒风险因素的多变量分析.
- 老年人未来跌倒的最一致的预测因素是过去一年的跌倒史和临床检测到的步态或平衡障碍.
- 视力障碍,药物使用,日常生活活动的限制和认知障碍并不总是预测跌倒;在控制其他因素后,静止性低血压不是一个显著的预测因素.
结论:
- 对跌倒风险的临床查应优先确定以前跌倒的患者.
- 对于那些没有先前跌倒史的人来说,评估步态和平衡是推的下一步.
- 患有摔倒病史或步行/平衡障碍的患者,未来跌倒的风险明显更高.
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