Will My Patient Fall?

医学 害怕跌倒 直立生命体征 奇纳 置信区间 心理干预 视力障碍 多元分析 老年人跌倒 前瞻性队列研究 梅德林 毒物控制 物理疗法 队列研究 伤害预防 急诊医学 内科学 精神科 政治学 血压 法学
作者
David A. Ganz,Yeran Bao,Paul G Shekelle,Laurence Z. Rubenstein
出处
期刊:JAMA [American Medical Association]
卷期号:297 (1): 77-77 被引量:763
标识
DOI:10.1001/jama.297.1.77
摘要

ContextEffective multifactorial interventions reduce the frequent falling rate of older patients by 30% to 40%. However, clinical consensus suggests reserving these interventions for high-risk patients. Limiting fall prevention programs to high-risk patients implies that clinicians must recognize features that predict future falls.ObjectiveTo identify the prognostic value of risk factors for future falls among older patients.Data Sources and Study SelectionSearch of MEDLINE (1966-September 2004), CINAHL (1982-September 2004), and authors' own files to identify prospective cohort studies of risk factors for falls that performed a multivariate analysis of such factors.Data ExtractionTwo reviewers independently determined inclusion of articles and assessed study quality. Disagreements were resolved by consensus. Included studies were those identifying the prognostic value of risk factors for future falls among community-dwelling persons 65 years and older. Clinically identifiable risk factors were identified across 6 domains: orthostatic hypotension, visual impairment, impairment of gait or balance, medication use, limitations in basic or instrumental activities of daily living, and cognitive impairment.Data SynthesisEighteen studies met inclusion criteria and provided a multivariate analysis including at least 1 of the risk factor domains. The estimated pretest probability of falling at least once in any given year for individuals 65 years and older was 27% (95% confidence interval, 19%-36%). Patients who have fallen in the past year are more likely to fall again [likelihood ratio range, 2.3-2.8]. The most consistent predictors of future falls are clinically detected abnormalities of gait or balance (likelihood ratio range, 1.7-2.4). Visual impairment, medication variables, decreased activities of daily living, and impaired cognition did not consistently predict falls across studies. Orthostatic hypotension did not predict falls after controlling for other factors.ConclusionsScreening for risk of falling during the clinical examination begins with determining if the patient has fallen in the past year. For patients who have not previously fallen, screening consists of an assessment of gait and balance. Patients who have fallen or who have a gait or balance problem are at higher risk of future falls.
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