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.2024.4166

摘要内容如下：

重要性

跌倒是老年人伤害相关发病率和死亡率的最常见原因。

目的

系统回顾社区老年人跌倒预防干预措施的有效性和危害的证据。

数据源

2016年1月1日至2023年5月8日期间发表的相关英文文献的MEDLINE、护理和联合健康文献累积索引（Cumulative Index for Nursing and Allied Health Literature）和Cochrane对照临床试验注册中心（Cochrane Central Register of Controlled Clinical Trials），持续监测至2024年3月22日。

研究选择

社区65岁及以上老年人预防跌倒干预措施的随机临床试验。

数据提取与合成

由2名独立审查员进行关键评估和数据提取。采用Knapp-Hartung校正的随机效应荟萃分析

主要成果和措施

跌倒、损伤性跌倒、与跌倒相关的骨折、住院或急诊就诊、一次或多次跌倒的人、损伤性跌倒的人、与跌倒相关的骨折的人和伤害。

结果

83项质量一般的随机临床试验（n=48839）检验了6种跌倒预防干预措施在老年人中的有效性。本文主要关注两种研究最多的干预类型：多因素（28项研究；N=27784）和运动（37项研究；N=16117）干预。多因素干预与跌倒（发生率比[IRR]，0.84[95%CI，0.74-0.95]）的统计学显著减少相关，但与1次或多次跌倒（相对风险[RR]，0.96[95%CI，0.91-1.02]）、损伤性跌倒（IRR，0.92[95%CI，0.84-1.01]）、跌倒相关骨折（IRR，1.01[95%CI，0.81-1.26]），损伤性跌倒的个体风险（RR，0.92[95%CI，0.83-1.02]），或跌倒相关骨折的个体风险（RR，0.86[95%CI，0.60-1.24]）。运动干预与跌倒（IRR，0.85[95%CI，0.75-0.96]）、一次或多次跌倒的个体风险（RR，0.92[95%CI，0.87-0.98]）和损伤性跌倒（IRR，0.84[95%CI，0.74-0.95]）的统计学显著减少相关，但与损伤性跌倒的个体风险（RR，0.90[95%CI，0.79-1.02]）无关。与多因素和运动干预相关的危害没有得到很好的报道，通常是罕见的，与运动相关的轻微肌肉骨骼症状。

结论和相关性

在多个高质量试验中，多因素和运动干预与跌倒减少相关。在多个与跌倒相关的结果中，运动表现出最一致的统计学显著益处。

英文原文如下：

Abstracts

Importance  Falls are the most common cause of injury-related morbidity and mortality in older adults.

Objective  To systematically review evidence on the effectiveness and harms of fall prevention interventions in community-dwelling older adults.

Data Sources  MEDLINE, Cumulative Index for Nursing and Allied Health Literature, and Cochrane Central Register of Controlled Clinical Trials for relevant English-language literature published between January 1, 2016, and May 8, 2023, with ongoing surveillance through March 22, 2024.

Study Selection  Randomized clinical trials of interventions to prevent falls in community-dwelling adults 65 years or older.

Data Extraction and Synthesis  Critical appraisal and data abstraction by 2 independent reviewers. Random-effects meta-analyses with Knapp-Hartung adjustment.

Main Outcomes and Measures  Falls, injurious falls, fall-related fractures, hospitalizations or emergency department visits, people with 1 or more falls, people with injurious falls, people with fall-related fractures, and harms.

Results  Eighty-three fair- to good-quality randomized clinical trials (n = 48 839) examined the effectiveness of 6 fall prevention interventions in older adults. This article focuses on the 2 most studied intervention types: multifactorial (28 studies; n = 27 784) and exercise (37 studies; n = 16 117) interventions. Multifactorial interventions were associated with a statistically significant reduction in falls (incidence rate ratio [IRR], 0.84 [95% CI, 0.74-0.95]) but not a statistically significant reduction in individual risk of 1 or more falls (relative risk [RR], 0.96 [95% CI, 0.91-1.02]), injurious falls (IRR, 0.92 [95% CI, 0.84-1.01]), fall-related fractures (IRR, 1.01 [95% CI, 0.81-1.26]), individual risk of injurious falls (RR, 0.92 [95% CI, 0.83-1.02]), or individual risk of fall-related fractures (RR, 0.86 [95% CI, 0.60-1.24]). Exercise interventions were associated with statistically significant reductions in falls (IRR, 0.85 [95% CI, 0.75-0.96]), individual risk of 1 or more falls (RR, 0.92 [95% CI, 0.87-0.98]), and injurious falls (IRR, 0.84 [95% CI, 0.74-0.95]) but not individual risk of injurious falls (RR, 0.90 [95% CI, 0.79-1.02]). Harms associated with multifactorial and exercise interventions were not well reported and were generally rare, minor musculoskeletal symptoms associated with exercise.

Conclusions and Relevance  Multifactorial and exercise interventions were associated with reduced falls in multiple good-quality trials. Exercise demonstrated the most consistent statistically significant benefit across multiple fall-related outcomes.

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