Reducing Fall Risk in Older Adults.
Reducing Fall Risk in Older Adults.
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DOI：
10.1097/01.naj.0000541429.36218.2d
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发表时间：
2018-07
期刊：
影响因子：
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通讯作者：
Luo F
中科院分区：
文献类型：
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作者：
Haddad YK;Bergen G;Luo F
2014年，超过四分之一的65岁及以上的美国成年人报告摔倒，十分之一的人报告与跌倒有关的伤害。1在老年人中，跌倒约占所有伤害相关急诊科就诊的60%，每年超过50%的伤害相关死亡。2跌倒的医学治疗率正在上升，老年人口正在增加，1如果不采取更多措施防止跌倒，这将给卫生保健系统带来重大负担。虽然老年人跌倒很常见，但可以通过针对可改变的风险因素，如前庭功能障碍、体位性低血压、视力障碍、足部问题和药物不良反应来预防跌倒。有效的循证干预包括参与物理治疗或锻炼计划，管理体位性低血压，转介给视力专家或足病医生，以及药物审查和管理。药物使用在老年人中很普遍，五分之四的人每天至少服用一种处方药，超过三分之一的人服用五种或更多。根据美国疾病控制与预防中心（CDC）未公布的数据，2013年，超过一半（53%）的老年人至少服用过一种与跌倒有关的药物。这使得药物管理成为降低跌倒风险的关键组成部分。用于治疗精神病、焦虑、抑郁、疼痛和睡眠障碍的精神活性药物会影响中枢神经系统，并可能导致增加跌倒风险的不良反应。根据未公布的疾病预防控制中心数据，与老年男性相比，老年女性患药物相关跌倒的风险更高，因为女性使用更多与跌倒相关的药物（57%对49%）。具体来说，老年妇女使用更多的阿片类药物（37%对33%）和苯二氮卓类药物（19%对11%）。为了应对预防老年人跌倒和跌倒相关伤害的需求，CDC制定了阻止老年人事故、死亡和伤害（STEADI）倡议，以指导护士和其他卫生保健提供者(1)筛查老年人跌倒风险，(2)评估可改变的风险因素，(3)通过使用有效的临床和社区策略进行干预以降低风险（见图1）。在CDC的STEADI网页上(www。疾病预防控制中心。gov/steadi)，护士可以访问steadi老年人跌倒预防在线
More than one in four American adults ages65 and older reported falling and one in 10 reported a fall-related injury in 2014. 1 Among older adults, falls account for approximately 60% of all injury-related ED visits and over 50% of injury-related deaths annually. 2 Rates of medically treated falls are rising and the older adult population is increasing, 1 which will result in a significant burden on the health care system if more is not done to prevent falls. Although falls among older adults are common, they can be prevented by targeting modifiable risk factors such as vestibular disorders, postural hypotension, vision impairment, foot problems, and medication adverse effects. Effective evidencebased interventions include participation in physical therapy or an exercise program, managing postural hypotension, referral to vision specialists or podiatrists, and medication review and management. 3 Medication use is prevalent in older adults, with four out of five taking at least one prescription medication daily and over a third taking five or more. 4 According to unpublished data from the Centers for Disease Control and Prevention (CDC), more than half of all older adults (53%) used at least one medication in 2013 whose adverse effects were linked to falls. This makes medication management a key component in reducing fall risk. Psychoactive medications used to treat psychosis, anxiety, depression, pain, and sleep disorders affect the central nervous system and can cause adverse effects that increase the risk of falls. According to the unpublished CDC data, older women are at an increased risk for medication-related falls compared with older men because women use more medications associated with falls (57% versus 49%). Specifically, older women use more opioids (37% versus 33%) and benzodiazepines (19% versus 11%). In response to the need to prevent falls and fallrelated injuries in older adults, the CDC has developed the Stopping Elderly Accidents, Deaths, and Injuries (STEADI) initiative to guide nurses and other health care providers in (1) screening older adults for fall risk,(2) assessing modifiable risk factors, and (3) intervening to reduce risk by using effective clinical and community strategies (see Figure 1). On the CDC’s STEADI web page (www. cdc. gov/steadi), nurses can access the STEADI Older Adult Fall Prevention Online