Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials
Interventions for the prevention of falls in older adults: systematic review and meta-analysis of randomised clinical trials
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DOI：
10.1136/bmj.328.7441.680
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发表时间：
2004-03-20
影响因子：
--
通讯作者：
Shekelle, PG
中科院分区：
文献类型：
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作者：
Chang, JT;Morton, SC;Shekelle, PG
目的评价常规护理组和对照组预防老年人跌倒干预措施的相对有效性。设计系统回顾和荟萃分析。数据来源Medline， HealthSTAR, Embase， Cochrane图书馆，其他健康相关数据库，以及来自综述文章和系统综述的参考文献列表。跌倒干预的组成部分：多因素跌倒风险评估，包括管理方案、锻炼、环境改变或教育。结果共纳入40项试验。随机效应分析结合试验与风险比数据显示跌倒风险降低（风险比0.88,95%可信区间0.82 ~ 0.95），而结合试验与发病率数据显示每月失败率降低（发病率比0.80,0.72 ~ 0.88）。通过meta回归评估各成分的影响。多因素跌倒风险评估和管理方案是最有效的跌倒风险（0.82,0.72至0.94，需要治疗的人数11人）和月跌倒率（0.63,0.49至0.83，治疗组每月每100名患者跌倒次数减少11.8次）。运动干预对跌倒风险（0.86,0.75 ~ 0.99，需治疗16例）和月跌倒率（0.86,0.73 ~ 1.01;2.7）也有有益的影响。结论预防老年人跌倒的干预措施在降低跌倒风险和每月跌倒率方面是有效的。最有效的干预措施是多因素跌倒风险评估和管理方案。锻炼计划在降低跌倒风险方面也很有效。
Objective To assess the relative effectiveness of interventions to prevent falls in older adults to either a usual care group or control group.Design Systematic review and meta-analyses.Data sources Medline, HealthSTAR, Embase, the Cochrane Library, other health related databases, and the reference lists from review articles and systematic reviews.Data extraction Components of falls intervention: multifactorial falls risk assessment with management programme, exercise, environmental modifications, or education.Results 40 trials were identified. A random effects analysis combining trials with risk ratio data showed a reduction in the risk of falling (risk ratio 0.88, 95% confidence interval 0.82 to 0.95), whereas combining trials with incidence rate data showed a reduction in the monthly rate of failing (incidence rate ratio 0.80, 0.72 to 0.88). The effect of individual components was assessed by meta-regression. A multifactorial falls risk assessment and management programme was the most effective component on risk of falling (0.82,0.72 to 0.94, number needed to treat 11) and monthly fall rate (0.63, 0.49 to 0.83; 11.8 fewer falls in treatment group per 100 patients per month). Exercise interventions also had a beneficial effect on the risk of falling (0.86, 0.75 to 0.99, number needed to treat 16) and monthly fall rate (0.86, 0.73 to 1.01; 2.7).Conclusions Interventions to prevent falls in older adults are effective in reducing both the risk of falling and the monthly rate of falling. The most effective intervention was a multifactorial falls risk assessment and management programme. Exercise programmes were also effective in reducing the risk of falling.