本文由小咖机器人翻译整理

期刊来源：JAMA

原文链接：https://doi.org/10.1001/jama.2024.1416

摘要内容如下：

重要性

每年有1400多万65岁或以上的美国成年人报告跌倒，并可能导致大量的发病率、死亡率和医疗保健支出。

观察

跌倒是由年龄相关的生理变化和多种内在和外在危险因素共同作用的结果。在社区居住的老年人中，主要可改变的危险因素包括步态和平衡障碍、直立性低血压、感觉障碍、药物和环境危害。指南建议，报告前一年跌倒、担心跌倒或步速低于0.8至1 m/s的个人应接受预防跌倒干预。在一项对高危人群平均风险的59项随机临床试验（RCT）进行的荟萃分析中，运动干预减少跌倒与干预组每1000患者年655次跌倒和非运动对照组每1000患者年850次跌倒相关（跌倒的比率[RR]为0.77；95%可信区间为0.71~0.83；跌倒人数的风险比为0.85；95%可信区间为0.81~0.89；风险差，7.2%；95%CI，5.2%-9.1%），大多数试验评估平衡和功能锻炼。在一项对43项干预措施的随机对照试验进行的荟萃分析中，这些干预措施系统地评估和解决了高危个体中的多种危险因素，多因素干预与干预组中每1000患者年1784次跌倒相关，而对照组中每1000患者年2317次跌倒相关（RR，0.77；95%CI，0.67-0.87），跌倒的人数没有显著差异。在随机对照试验和半随机试验的荟萃分析中，与减少跌倒相关的其他干预措施包括白内障手术（8项研究，1834名患者；风险比[RR]，0.68；95%CI，0.48-0.96），多成分足病干预（3项研究，1358例患者；相对危险度为0.77；95%CI，0.61-0.99）和高危个体的环境改变（12项研究，5293名患者；RR为0.74；95%可信区间，0.61-0.91）。尽管取消处方是许多成功的多因素干预措施的组成部分，但对停止与跌倒相关的药物治疗项目的随机对照试验进行的荟萃分析并未发现显著减少。

结论和相关性

每年有超过25%的老年人跌倒，跌倒是65岁及以上老年人伤害相关死亡的主要原因。建议在高危人群的平均风险中进行功能锻炼，以提高腿部力量和平衡能力，从而预防跌倒。基于可改变危险因素的系统临床评估的多因素风险降低可能会降低高危人群的跌倒率。

英文原文如下：

Abstracts

Importance  Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures.

Observations  Falls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards. Guidelines recommend that individuals who report a fall in the prior year, have concerns about falling, or have gait speed less than 0.8 to 1 m/s should receive fall prevention interventions. In a meta-analysis of 59 randomized clinical trials (RCTs) in average-risk to high-risk populations, exercise interventions to reduce falls were associated with 655 falls per 1000 patient-years in intervention groups vs 850 falls per 1000 patient-years in nonexercise control groups (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; risk ratio for number of people who fall, 0.85; 95% CI, 0.81-0.89; risk difference, 7.2%; 95% CI, 5.2%-9.1%), with most trials assessing balance and functional exercises. In a meta-analysis of 43 RCTs of interventions that systematically assessed and addressed multiple risk factors among individuals at high risk, multifactorial interventions were associated with 1784 falls per 1000 patient-years in intervention groups vs 2317 falls per 1000 patient-years in control groups (RR, 0.77; 95% CI, 0.67-0.87) without a significant difference in the number of individuals who fell. Other interventions associated with decreased falls in meta-analysis of RCTs and quasi-randomized trials include surgery to remove cataracts (8 studies with 1834 patients; risk ratio [RR], 0.68; 95% CI, 0.48-0.96), multicomponent podiatry interventions (3 studies with 1358 patients; RR, 0.77; 95% CI, 0.61-0.99), and environmental modifications for individuals at high risk (12 studies with 5293 patients; RR, 0.74; 95% CI, 0.61-0.91). Meta-analysis of RCTs of programs to stop medications associated with falls have not found a significant reduction, although deprescribing is a component of many successful multifactorial interventions.

Conclusions and Relevance  More than 25% of older adults fall each year, and falls are the leading cause of injury-related death in persons aged 65 years or older. Functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. Multifactorial risk reduction based on a systematic clinical assessment for modifiable risk factors may reduce fall rates among those at high risk.

-----------分割线---------

点击链接：https://www.mediecogroup.com/community/user/vip/categories/ ，成为医咖会员，获取12项专属权益。