ImportanceFalls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, and health care expenditures.ObservationsFalls result from age-related physiologic changes compounded by multiple intrinsic and extrinsic risk factors. Major modifiable risk factors among community-dwelling older adults include gait and balance disorders, orthostatic hypotension, sensory impairment, medications, and environmental hazards. Guidelines recommend that individuals who report a fall in the prior year, have concerns about falling, or have gait speed less than 0.8 to 1 m/s should receive fall prevention interventions. In a meta-analysis of 59 randomized clinical trials (RCTs) in average-risk to high-risk populations, exercise interventions to reduce falls were associated with 655 falls per 1000 patient-years in intervention groups vs 850 falls per 1000 patient-years in nonexercise control groups (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; risk ratio for number of people who fall, 0.85; 95% CI, 0.81-0.89; risk difference, 7.2%; 95% CI, 5.2%-9.1%), with most trials assessing balance and functional exercises. In a meta-analysis of 43 RCTs of interventions that systematically assessed and addressed multiple risk factors among individuals at high risk, multifactorial interventions were associated with 1784 falls per 1000 patient-years in intervention groups vs 2317 falls per 1000 patient-years in control groups (RR, 0.77; 95% CI, 0.67-0.87) without a significant difference in the number of individuals who fell. Other interventions associated with decreased falls in meta-analysis of RCTs and quasi-randomized trials include surgery to remove cataracts (8 studies with 1834 patients; risk ratio [RR], 0.68; 95% CI, 0.48-0.96), multicomponent podiatry interventions (3 studies with 1358 patients; RR, 0.77; 95% CI, 0.61-0.99), and environmental modifications for individuals at high risk (12 studies with 5293 patients; RR, 0.74; 95% CI, 0.61-0.91). Meta-analysis of RCTs of programs to stop medications associated with falls have not found a significant reduction, although deprescribing is a component of many successful multifactorial interventions.Conclusions and RelevanceMore than 25% of older adults fall each year, and falls are the leading cause of injury-related death in persons aged 65 years or older. Functional exercises to improve leg strength and balance are recommended for fall prevention in average-risk to high-risk populations. Multifactorial risk reduction based on a systematic clinical assessment for modifiable risk factors may reduce fall rates among those at high risk.

中文翻译：

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社区老年人跌倒的风险评估和预防

重要性 每年有超过 1400 万 65 岁或以上的美国成年人报告跌倒，并可能导致大量的发病率、死亡率和医疗保健支出。观察结果跌倒是由与年龄相关的生理变化加上多种内在和外在风险因素造成的。社区老年人的主要可改变危险因素包括步态和平衡障碍、直立性低血压、感觉障碍、药物和环境危害。指南建议，上一年报告跌倒、担心跌倒或步态速度低于 0.8 至 1 m/s 的个人应接受跌倒预防干预措施。在对平均风险到高风险人群的 59 项随机临床试验 (RCT) 进行的荟萃分析中，减少跌倒的运动干预与干预组中每 1000 名患者年 655 例跌倒相关，而干预组中每 1000 名患者年 850 例跌倒相关。非运动对照组（跌倒发生率 [RR]，0.77；95% CI，0.71-0.83；跌倒人数风险比，0.85；95% CI，0.81-0.89；风险差异，7.2%；95% CI， ，5.2%-9.1%），大多数试验评估平衡和功能锻炼。在对 43 项干预措施的随机对照试验进行的荟萃分析中，系统地评估和解决了高危个体中的多种危险因素，多因素干预与干预组中每 1000 患者年 1784 例跌倒相关，而对照组每 1000 患者年 2317 例跌倒相关（RR，0.77；95% CI，0.67-0.87）跌倒人数没有显着差异。随机对照试验和半随机试验的荟萃分析中与减少跌倒相关的其他干预措施包括白内障摘除手术（8 项研究，涉及 1834 名患者；风险比 [RR]，0.68；95% CI，0.48-0.96）、多成分足病干预措施（ 3 项研究涉及 1358 名患者；RR，0.77；95% CI，0.61-0.99），以及针对高危个体的环境改变（12 项研究涉及 5293 名患者；RR，0.74；95% CI，0.61-0.91）。尽管取消处方是许多成功的多因素干预措施的组成部分，但对停止与跌倒相关的药物治疗方案的随机对照试验（RCT）并没有发现显着减少。结论和相关性每年有超过 25% 的老年人跌倒，跌倒是主要原因65 岁或以上人员因伤害而死亡的比例。建议通过功能锻炼来提高腿部力量和平衡能力，以预防中危至高危人群跌倒。基于对可改变风险因素的系统临床评估的多因素风险降低可能会降低高风险人群的跌倒率。