社区老年人跌倒的原因与预防

随着人口的老龄化，预防卧床不起已成为重要的研究课题。不少老年人因跌倒骨折而卧床；即使未骨折，跌倒使患者丧失信心、恐惧引起活动能力下降、活动范围受限、生活质量下降(跌倒后综合征)，进而更易跌倒而造成恶性循环。跌倒无论对个人生活质量还是医疗费用都有明显影响，因此，分析跌倒的原因以便预防跌倒具有重大意义。     

基于跌倒效能系统评价Otago家庭运动预防老年人日常跌倒损伤的效果

目的:系统评价Otago家庭运动在预防老年人跌倒损伤方面的干预效果。方法:计算机检索Pub Med、Medline(Pro Quest)、CINAHL、Science Direct、EBSCO、The Cochrane Library、中国知网和万方等数据库中相关的随机对照试验(RCT),检索至2016年7月。采用Cochrane协作网中RCT的偏倚风险评价标准进行方法学质量评估,应用Rev Man 5.3软件进行meta分析数据合成,采用Stata 12.0软件进行meta回归分析和潜在发表偏倚分析。结果:总共9个RCT,1336例受试者被纳入meta分析,数据表明,经过3—12个月的Otago家庭运动训练,干预组受试者的跌倒效能量表评分提高程度显著优于对照组[SMD=0.27,95%CI(0.04,0.49),P=0.02],且平衡能力改善更多[SMD=0.29,95%CI(0.13,0.45),P=0.0004],但尚未发现其在降低老年人一次性跌倒数量和提高步速水平、日常活动能力和生存质量等方面的显著优势(P0.05)。结论:Otago家庭运动训练计划能够显著提高老年人日常活动中的跌倒效能,减轻老年人生活中的跌倒恐惧心理,推荐其用于老年人日常跌倒损伤的预防。     

预防老年人跌倒的社区护理

对老年人予以跌倒危险因素进行评估,采取相应护理措施,提高社区护理人员和老人的安全防范意识,建立良好的生活习惯和居住环境是预防老年人跌倒的关键。     

社区老年人跌倒的评估及预防研究进展

通过对国内外有关社区老年人跌倒危险的测定方法及评估量表的归纳总结,从体育锻炼、居家环境改造、药物保健、健康教育、应用辅助器械等方面来阐述近几年预防老人跌倒所采取的措施,以最大限度预防及减少社区老年人跌倒的发生。     

Tetrax跌倒指数测定对社区老年人跌倒预防的效果

目的探讨老年人跌倒的发生与Tetrax跌倒指数的关系,评估按照该指数进行健康宣教的效果,为老年人跌倒预防提供科学依据。方法便利抽样选择上海市宝山区某社区的60岁以上老年人300名,随机分为观察组和对照组各150例。观察组给予Tetrax跌倒指数测定,并且通过机器数据语言获取老年人跌倒的风险指数及来源,同时进行有针对性的预防跌倒宣教及康复治疗;对照组通过社区活动实施预防跌倒宣教。统计1年后两组老年人跌倒发生情况,并分析Tetrax跌倒指数高低与跌倒发生率、疾病之间的关系。结果观察组老年人跌跤发生率明显低于对照组(P0.05);不同Tetrax跌倒风险级别及患不同慢性疾病的老年人跌倒发生率存在差异(P0.05)。结论 Tetrax跌倒指数测定并参照该指数进行重点宣教,有助于降低老年人跌倒风险,为老年人跌倒的预防提供科学依据。     

运动训练预防老年人跌倒的研究现状及展望

介绍运动训练预防老年人跌倒的生物力学原因以及运动处方(运动训练形式、强度、时间和频率),并对老年人跌倒预防的预防训练进行展望。     

社区老年人预防跌倒意识行为的调查研究

目的探讨社区老年人预防跌倒意识行为现状。方法 2014年1—10月采用方便抽样法抽取上海市浦东新区北蔡社区4个居委老年人265例,应用《老年住院患者预防跌倒意识行为问卷调查表》进行预防跌倒意识行为调查。结果 26.20%的老年人知晓所服药物可能会导致跌倒并知道防范方法,26.79%外出或者活动时需陪伴,38.49%的老年人害怕跌倒。结论社区老年人预防跌倒意识行为有待增强,应制定有针对性的健康教育和干预措施。     

社区老年人跌倒的原因与预防

随着人口的老龄化,预防卧床不起已成为重要的研究课题。不少老年人因跌倒骨折而卧床;即使未骨折,跌倒使患者丧失信心、恐惧引起活动能力下降、活动范围受限、生活质量下降(跌倒后综合征),进而更易跌倒而造成恶性循环。跌倒无论对个人生活质量还是医疗费用都有明显影响,因此,分析跌倒的原因以便预防跌倒具有重大意义。     

运动锻炼降低老年人跌倒恐惧的研究进展

总结并分析了国内外利用运动锻炼降低老年人跌倒恐惧的文献,主要包括太极、普拉提和瑜伽、奥塔戈运动项目、平衡训练以及运动锻炼+,以期为国内跌倒恐惧的老年人制定有效的运动锻炼方案提供依据。     

Long-term follow-up of exercise interventions aimed at preventing falls in older people living in the community: a systematic review and meta-analysis

BackgroundFall-related injuries are the leading cause of accident-related mortality for older adults, with 30% of those aged 65 years and over falling annually. Exercise is effective in reducing rate and risk of falls in community-dwelling adults; however, there is lack of evidence for the long-term effects of exercise.ObjectivesTo assess the long-term effect of exercise interventions on preventing falls in community-dwelling older adults.Data SourcesSearches were undertaken on MEDLINE, EMBASE, AMED, CINAHL, psycINFO, the Physiotherapy Evidence Database (PEDro) and The Cochrane Library from inception to April 2017.Study selectionRandomised controlled trials (RCTs), cohort studies or secondary analyses of RCTs with long-term follow-up (>12 months) of exercise interventions involving community-dwelling older adults (65 and over) compared to a control group.Data extraction/ Data synthesisPairs of review authors independently extracted data. Review Manager (RevMan 5.1) was used for meta-analysis and data were extracted using rate ratio (RaR) and risk ratio (RR).ResultsTwenty-four studies (7818 participants) were included. The overall pooled estimate of the effect of exercise on rate of falling beyond 12-month follow-up was rate ratio (RaR) 0.79 (95% confidence interval (CI) 0.71 to 0.88) and risk of falling was risk ratio (RR) 0.83 (95% CI 0.76 to 0.92) Subgroup analyses revealed that there was no sustained effect on rate or risk of falling beyond two years post intervention.ConclusionsFalls prevention exercise programmes have sustained long-term effects on the number of people falling and the number of falls for up to two years after an exercise intervention.Systematic review registration numberCRD42017062461.     

Dosage for cost-effective exercise-based falls prevention programs for older people: A systematic review of economic evaluations

BackgroundFalls in older people is a global public health concern. Physical exercise is a useful and potentially cost-saving treatment option to prevent falls in older people.ObjectivesWe aimed to (1) summarize the research literature regarding the cost-effectiveness of exercise-based programs for falls prevention in older people and (2) discuss the implications of the review's findings for clinical practice and future research on the dosage of cost-effective exercise-based falls prevention programs for older people.MethodsMultiple databases were searched from inception until February 2019. Studies were included if they (1) were randomized controlled trials with an economic evaluation of exercise-based falls prevention programs for people ≥ 60 years old and (2) assessed the incremental cost-effectiveness ratios, cost per quality-adjusted life year, incremental cost per fall and benefit-to-cost ratio of programs. Methodological quality was assessed with the Physiotherapy Evidence Database scale and quality of economic evaluation with the Quality of Health Economic Studies.ResultsWe included 12 studies (3668 older people). Interventions for falls prevention were either exercise-only or multifactorial programs. Five studies of high economic quality and 2 of high methodological quality provided evidence supporting exercise-only programs as cost-effective for preventing falls in older people. Specifically, a tailored exercise program including strengthening of lower extremities, balance training, cardiovascular exercise, stretching and functional training of moderate intensity performed twice per week with each session lasting 60 min for ≥ 6 months delivered in groups of 3 to 8 participants with home-based follow-up appears to be cost-effective in preventing falls in older people.ConclusionThere is evidence to support exercise-based interventions as cost-effective treatment for preventing falls. Further research is needed to fully establish the cost-effectiveness of such programs, especially in both developing and underdeveloped countries.Review registrationPROSPERO CRD42018102892.     

Pilates exercise and postural balance in older adults: A systematic review and meta-analysis of randomized controlled trials

IntroductionThe effects of exercising with the Pilates method on aspects such as balance for the general population have been reported by recent systematic reviews. However, whereas the effects of the Pilates method on improving general balance have been well studied, less is known about postural balance and the respective determinants of Pilates effects.Objectives(1) provide more up-to-date evidence to determine the effects of Pilates on postural balance and (2) examine the effects of length of intervention, Pilates amount per week (times per week X session duration), and study quality (risk of bias) on postural balance in older adults.MethodsA systematic electronic search in Medline and Scientific Electronic Library Online (SciELO) was completed in December 2018 identifying randomized controlled trials investigating the effect of a Pilates method on postural balance in healthy older adults. A subsequent meta-analysis was performed.ResultsThe meta-analysis involved 6 studies and 261 individuals (128 Pilates and 133 control groups). We observed an overall effect favoring the Pilates group SMD_95% = 0.89 [0.29–1.49]. The subgroup mean effects were similar for “length of intervention” (low vs high) [P = 0.557], “Pilates amount per week” (low vs high) [P = 0.565], and “study quality” (low vs high) [P = 0.869].ConclusionAccordingly, our findings suggest that a Pilates training program can be considered as an effective form of exercise to improve balance in older adults. Additionally, length of intervention, Pilates amount per week, and study quality were not related to the magnitude of effect on postural balance.     

Effect of Baduanjin exercise on the cognitive function of middle-aged and older adults: A systematic review and meta-analysis

BackgroundAge-related cognitive decline is a pervasive problem in the ageing population. Baduanjin training is a mind-body exercise with the characteristics of traditional Chinese medicine, and increasing numbers of studies have reported its usefulness in modulating the cognitive performance of various populations. However, no systematic review has evaluated the effect of Baduanjin training on cognition in middle-aged and older adults.ObjectiveTo systematically evaluate the effects of Baduanjin on the global cognitive function and specific cognitive domains of middle-aged and elderly people.MethodsFour literature databases (PubMed, Cochrane library, EMBASE, and Web of Science) and four Chinese databases (Wanfang, China National Knowledge Infrastructure, Chinese Science and Technology Periodical and China Biology Medicine) were searched from inception through May 2020. Randomized controlled trials (RCTs) examining the effect of Baduanjin exercise on the cognitive function of middle-aged and elderly people were included. Assessment of the risk of bias for the included studies and data synthesis were conducted using the software Review Manager 5.3 based on the methods given in the Cochrane Handbook.ResultsBaduanjin training showed significant benefit for global cognitive function and parts of specific domains of cognition, including general memory and its sub-domains (i.e., immediate memory and delayed memory), executive function, and processing speed, but no significant difference was found in attention function, visual-spatial ability or long-term memory (a sub-domain of memory). No related adverse events were reported in the included studies.ConclusionsThe findings of this review suggest that Baduanjin is safe and effective in enhancing global cognitive function and memory in middle-aged and older adults and potentially beneficial to parts of the other specific domains of cognition, including executive function and processing speed. However, additional trials with larger sample sizes and a more rigorous design are needed before more definitive conclusions can be drawn.     

Cultural influences on exercise participation and fall prevention: a systematic review and narrative synthesis

Purpose: We aim to provide a systematic review of qualitative research evidence relevant to the experiences and perceptions of program providers and participants from culturally and linguistically diverse (CALD) backgrounds regarding (i) exercise and (ii) fall prevention programs for older people. Method: Using a narrative synthesis approach, we reviewed published journal articles reporting qualitative data. Electronic and manual literature searches were conducted to identify 19 publications that met the inclusion criteria. Of these, 16 discussed exercise and three focused on broader fall prevention programs. However, no studies were identified that explored the perspective of the program providers. Results: An overarching theme emerged identifying the influence of cultural values and perceptions on program participation. Also, identified were motivational, social and environmental influences. Conclusion: Exercise and fall prevention interventions need to be culturally appropriate and utilise the positive influences of social support, especially from physicians and family. While these findings can be used to inform the delivery of programs to these population groups, future studies should focus specifically on experiences and perceptions of older CALD people of fall prevention programs as well as the perspectives of program providers.

• Implications for Rehabilitation

• Program participation is influenced by cultural values and motivational, social and environmental factors.

• The meaning and importance of exercise can vary between and within cultures.

• Exercise and fall prevention interventions need to be culturally appropriate and utilise the positive influences of social support, especially from physicians and family.

• Providing information that falls can be prevented and the reasons why behaviours need to change will be more likely to encourage older people from CALD backgrounds to contemplate participation.

     

Health professionals' attitudes toward older people and older patients: A systematic review

Attitudes toward older people and older patients among healthcare professionals are of concern throughout the world, but there are no recent systematic reviews which have examined and compared the attitudes across the various healthcare professionals who provide healthcare to older people. A comprehensive literature search (2000–2011) was undertaken on electronic databases (CINAHL, MEDLINE, EMBASE, British Nursing Index, PsycINFO, Chinese Biomedical database, China Medical Academic Conference and China Academic Journal) using a combination of terms. We identified 2179 articles indexed with these terms. Initial screening was undertaken by two researchers and then checked by a third researcher. In total, the reviewers selected 117 articles which, on the basis of their abstracts, appeared to meet the criteria for inclusion. We obtained the full texts and two reviewers assessed each full text paper to further examine whether it met all the criteria. The final review identified 51 studies. Publications over the last 10 years show that attitudes towards older people and older patients range from neutral to positive among healthcare professionals and highlight the need for well-designed studies of both qualified and student healthcare professionals recruiting random samples across multiple sites and utilizing validated instruments consistently to permit comparison over time and across countries.