Will my patient fall?

被引:607
作者
Ganz, David A.
Bao, Yeran
Shekelle, Paul G.
Rubenstein, Laurence Z.
机构
[1] Vet Affairs Greater Los Angeles Hlth Care Syst, Vet Affairs Geriatr Res Educ & Clin Ctr 11G, Los Angeles, CA 90073 USA
[2] Univ Calif Los Angeles, Multicampus Program Geriatr Med & Gerontol, Los Angeles, CA USA
[3] Robert Wood Johnson Clin Scholars Program, Los Angeles, CA USA
[4] RAND Hlth, Santa Monica, CA USA
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 2007年 / 297卷 / 01期
关键词
RISK-FACTORS; RECURRENT FALLS; OLDER-PEOPLE; COMMUNITY; PREDICTORS; METAANALYSIS; OSTEOARTHRITIS; MOBILITY; DRUGS;
D O I
10.1001/jama.297.1.77
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Context Effective 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. Objective To identify the prognostic value of risk factors for future falls among older patients. Data Sources and Study Selection Search 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 Extraction Two 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 Synthesis Eighteen 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. Conclusions Screening 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.
引用
收藏
页码:77 / 86
页数:10
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