Toby Jack Ellmers, Jodi P Ventre, Ellen Freiberger, Klaus Hauer, David B Hogan, Mei Ling Lim, Lisa McGarrigle, Samuel Robert Nyman, Chris J Todd, Yuxiao Li, Kim Delbaere
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MEDLINE, CINAHL Plus, Web of Science and PsycINFO were searched for studies examining associations between baseline concerns about falling and future falls in older adults (minimum 6-month follow-up). Meta-analyses examined associations between concerns about falling and future falls. Risk of bias was assessed using an adapted Newcastle Ottawa Scale for cohort studies, and evidence certainty was rated with GRADE.</p><p><strong>Results: </strong>About 53 studies, comprising 75,076 participants, were included. Meta-analysis showed significant independent association between baseline concerns and future falls when using the Falls Efficacy Scale-International to assess concerns (full scale version, pooled OR = 1.03 [95% CI = 1.02-1.05] per 1-point increase; short scale version, pooled OR = 1.08 [95% CI = 1.05-1.11]). Significant associations were also observed when using single-item measures of concerns (pooled OR = 1.60 [95% CI = 1.36-1.89] for high vs. low concerns). 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引用次数: 0
摘要
背景:《2022年世界跌倒指南》建议在多因素跌倒风险评估中评估对跌倒的担忧(或“恐惧”)。然而,这一建议的证据基础是有限的。本综述运用布拉德福德希尔因果关系标准,评估了有关跌倒的证据,将其作为未来跌倒的独立预测因素。方法:进行系统评价和荟萃分析(PROSPERO注册ID: CRD42023387212)。我们检索了MEDLINE、CINAHL Plus、Web of Science和PsycINFO,以研究老年人跌倒的基线担忧与未来跌倒之间的关系(至少6个月的随访)。荟萃分析研究了担心摔倒和未来摔倒之间的联系。采用队列研究的纽卡斯尔渥太华量表评估偏倚风险,证据确定性评分为GRADE。结果:共纳入53项研究,75,076名参与者。荟萃分析显示,当使用国际跌倒疗效量表(full scale version,合并OR = 1.03 [95% CI = 1.02-1.05])评估担忧时,基线担忧与未来跌倒之间存在显著的独立关联(全量表版本);短尺度版本,合并OR = 1.08 [95% CI = 1.05-1.11])。当使用单项关注指标时,也观察到显著的关联(高关注与低关注的合并OR = 1.60 [95% CI = 1.36-1.89])。相比之下,平衡置信度(特定活动平衡置信度量表)不能预测未来的跌倒(合并OR = 0.97 [95% CI = 0.93-1.01])。尽管有26项研究被评为质量差,但不同质量的研究之间的关联是一致的。证据的总体确定性被评为中等。结论:对跌倒的基线担忧是老年人未来跌倒的明确预测指标,支持将其纳入跌倒风险评估。定期评估对跌倒的担忧,以及有针对性的干预,可以帮助降低老年人跌倒的风险。
Does concern about falling predict future falls in older adults? A systematic review and meta-analysis.
Background: The 2022 World Falls Guidelines recommend assessing concerns (or 'fears') about falling in multifactorial fall risk assessments. However, the evidence base for this recommendation is limited. This review evaluated the evidence for concerns about falling as an independent predictor of future falls, applying the Bradford Hill criteria for causality.
Methods: Systematic review and meta-analyses were conducted (PROSPERO registration ID: CRD42023387212). MEDLINE, CINAHL Plus, Web of Science and PsycINFO were searched for studies examining associations between baseline concerns about falling and future falls in older adults (minimum 6-month follow-up). Meta-analyses examined associations between concerns about falling and future falls. Risk of bias was assessed using an adapted Newcastle Ottawa Scale for cohort studies, and evidence certainty was rated with GRADE.
Results: About 53 studies, comprising 75,076 participants, were included. Meta-analysis showed significant independent association between baseline concerns and future falls when using the Falls Efficacy Scale-International to assess concerns (full scale version, pooled OR = 1.03 [95% CI = 1.02-1.05] per 1-point increase; short scale version, pooled OR = 1.08 [95% CI = 1.05-1.11]). Significant associations were also observed when using single-item measures of concerns (pooled OR = 1.60 [95% CI = 1.36-1.89] for high vs. low concerns). In contrast, balance confidence (Activities-Specific Balance Confidence Scale) did not predict future falls (pooled OR = 0.97 [95% CI = 0.93-1.01]). Despite 26 studies rated as poor quality, associations were consistent across studies of different quality. The overall certainty of the evidence was rated as moderate.
Conclusions: Baseline concern about falling is a clear predictor of future falls in older adults, supporting its inclusion in fall risk assessments. Regular assessment of concerns about falling, along with targeted interventions, could help reduce the risk of falls in older adults.
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.