HOW TO MANAGE RECURRENT FALLS IN CLINICAL PRACTICE: GUIDELINES OF THE FRENCH SOCIETY OF GERIATRICS AND GERONTOLOGY
HOW TO MANAGE RECURRENT FALLS IN CLINICAL PRACTICE: GUIDELINES OF THE FRENCH SOCIETY OF GERIATRICS AND GERONTOLOGY
复制标题
DOI：
10.1007/s12603-011-0016-6
复制
发表时间：
2011-01-01
影响因子：
5.8
通讯作者：
Belmin, J.
中科院分区：
文献类型：
--
作者：
Beauchet, O.;Dubost, V.;Belmin, J.
背景：医疗保健专业人员需要一种简单实用的临床方法来管理临床常规中的复发性跌倒。目的：制定临床实践建议，旨在帮助医疗保健专业人员，特别是在初级保健中管理复发性福尔斯。方法：采用Medline、Embase、Pascal和科克伦文献进行系统的英文和法文综述。检索了截至2008年7月31日发表的系统综述、荟萃分析、对照试验、队列研究、病例对照研究和横向研究。使用以下医学主题标题（MeSH）术语：“老年或80岁及以上”、“体弱老年人”、“意外跌倒”、“精神回忆”和“复发性福尔斯”。这些准则是由一个由专家和从业人员组成的多学科工作组根据高级卫生管理局的方法拟订的。结果如下：跌倒是指导致受试者无意中躺在地面或地板或其他较低水平上的事件，一旦受试者在12个月内报告至少2次福尔斯，则应视为复发事件。经常性福尔斯跌倒需要及时和适当的管理，首要目标是系统地评估福尔斯跌倒的严重程度。跌倒严重程度的评估应基于标准化问卷和体格检查。建议在临床检查无特定指征的情况下不进行脑成像，并在跌倒后一周内重新评估受试者。在进行任何干预之前和评估严重程度体征之后，建议系统评估福尔斯的风险因素。这种评估应基于使用经验证的标准化测试。为了实施适当的干预措施，需要对复发性跌倒者及其护理人员进行教育。在步态和/或平衡障碍的情况下，建议进行物理治疗。有规律的身体活动应该进行低到中等强度的运动。建议在治疗期间和每次治疗后与专业人士进行康复锻炼，以将康复益处扩展到日常生活中。结论：临床指南侧重于管理（即，诊断、评估和治疗）。他们提供了以下临床问题的答案：1）如何定义复发性福尔斯？2)如何识别严重的福尔斯？3)如何评估复发性福尔斯？4）如何治疗复发性福尔斯？
Background: Health care professionals need a simple and pragmatic clinical approach for the management of recurrent fallers in clinical routine. Objective: To develop clinical practice recommendations with the aim to assist health care professionals, especially in primary care in the management of recurrent falls. Methods: A systematic English and French review was conducted using Medline, Embase, Pascal and Cochrane literature. Search included systematic reviews, meta-analyses, controlled trials, cohort studies, case-control studies and transversal studies published until July 31, 2008. The following Medical Subject Heading (MeSH) terms were used: "aged OR aged, 80 and over", "frail elderly", "Accidental Fall", "Mental Recall", and "Recurrent falls". The guidelines were elaborated according the Haute Autorite de Sante methods by a multidisciplinary working group comprising experts and practitioners. Results: A fall is an event that results in a person coming to rest inadvertently on the ground or floor or other lower level and should be considered as a recurrent event as soon as a subject reported at least two falls in a 12-month period. Recurrent falls impose a prompt and appropriate management with the first aim to systematically evaluate the severity of falls. The evaluation of fall severity should be based on a standardized questionnaire and physical examination. It is recommended not to perform cerebral imaging in the absence of specific indication based on the clinical examination and to reevaluate the subject within a week after the fall. Prior to any intervention and after an evaluation of signs of severity, it is recommended to systematically assess the risk factors for falls. This evaluation should be based on the use of validated and standardized tests. The education of recurrent fallers and their care givers is required in order to implement appropriate intervention. In the event of a gait and/or balance disorders, it is recommended to prescribe physiotherapy. A regular physical activity should be performed with low to moderate intensity exercise. It is recommended to perform rehabilitation exercises with a professional, between therapy sessions and after each session, in order to extend rehabilitation benefits to the daily life. Conclusion: The clinical guidelines focused on management (i.e., diagnosis, assessment and treatment) of recurrent falls in clinical routine. They provide answers to the following clinical questions: 1) How to define recurrent falls? 2) How to identify severe falls? 3) How to assess recurrent falls? and 4) How to treat recurrent falls?