Charlotte Eost-Telling, Lucy McNally, Yang Yang, Chunhu Shi, Gill Norman, Saima Ahmed, Brenda Poku, Annemarie Money, Helen Hawley-Hague, Chris J Todd, Susan Deborah Shenkin, Emma R L C Vardy
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Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (risk ratio 6.66; 95% confidence interval (CI) 2.16-20.53), but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled odds ratio 2.01; 95% CI 1.52-2.66); one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns.</p><p><strong>Conclusions: </strong>We found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship and establish how and why this operates bidirectionally. Studies must consider confounding factors such as dementia, frailty and comorbidity in their design, to identify potential modifying factors involved. 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引用次数: 0
摘要
目的:系统回顾和批判性评价≥60岁社区居民谵妄和跌倒之间关联的证据。方法:于2023年4月检索EMBASE、MEDLINE、PsycINFO、Cochrane Database of Systematic Reviews、CINAHL和循证医学评论数据库。使用标准方法筛选、提取数据、评估偏倚风险(使用纽卡斯尔-渥太华量表)、提供叙事综合,并在适当情况下进行荟萃分析。结果:我们纳入了8项研究,至少有3505名独特的参与者。五项研究发现谵妄与随后的跌倒之间存在有限的关联:一项调整后的研究显示跌倒增加(风险比6.66;95%可信区间(CI) 2.16-20.53),但证据的确定性较低。四项未经调整的研究没有发现明显的效果。三项研究(其中一项有两个亚组分别处理)发现跌倒与随后的谵妄之间存在关联的一些证据:三项经调整的研究的荟萃分析显示谵妄增加(合并优势比2.01;95% ci 1.52-2.66);一组未经调整的数据没有发现明显的影响。研究报告了跌倒和被跌倒者的数量。四项研究和一个亚组存在高偏倚风险,一项研究存在一些担忧。结论:我们发现谵妄和跌倒之间的关联证据有限。需要更多方法上严谨的研究来理解这种复杂的关系,并确定这种关系如何以及为什么是双向的。研究必须在设计中考虑痴呆、虚弱和合并症等混杂因素,以确定涉及的潜在修饰因素。临床医生应该意识到这些常见表现之间的潜在关系。
The association between delirium and falls in older adults in the community: a systematic review and meta-analysis.
Objective: Systematically review and critically appraise the evidence for the association between delirium and falls in community-dwelling adults aged ≥60 years.
Methods: We searched EMBASE, MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Evidence-Based Medicine Reviews databases in April 2023. Standard methods were used to screen, extract data, assess risk of bias (using Newcastle-Ottawa scale), provide a narrative synthesis and, where appropriate, conduct meta-analysis.
Results: We included 8 studies, with at least 3505 unique participants. Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (risk ratio 6.66; 95% confidence interval (CI) 2.16-20.53), but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled odds ratio 2.01; 95% CI 1.52-2.66); one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns.
Conclusions: We found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship and establish how and why this operates bidirectionally. Studies must consider confounding factors such as dementia, frailty and comorbidity in their design, to identify potential modifying factors involved. Clinicians should be aware of the potential relationship between these common presentations.
期刊介绍:
Age and Ageing is an international journal publishing refereed original articles and commissioned reviews on geriatric medicine and gerontology. Its range includes research on ageing and clinical, epidemiological, and psychological aspects of later life.