中国老年人跌倒危险因素的Meta分析

Meta-analysis of risk factors for fall in Chinese elderly

[目的]通过Meta分析明确中国老年人跌倒的危险因素。[方法]计算机检索中国生物医学文献数据库、中国知网、万方数据库、维普中文期刊数据库、PubMed、Ovid、Web of Science、CINAHL,收集公开发表的国内外中国老年人跌倒危险因素的病例对照研究、队列研究和横断面研究。筛选符合标准的文献,应用RevMan 5.3软件进行Meta分析。[结果]共纳入23篇文献,5篇病例对照研究、3篇队列研究、15篇横断面研究,合计跌倒组4 582例、未跌倒组19 121例。中国老年人跌倒的危险因素及相应的OR、95%CI为:年龄≥75岁1.43[1.25,1.63]、女性1.43[1.32,1.56]、使用助行器2.39[2.10,2.73]、步态不稳4.18[2.72,6.43]、害怕跌倒2.47[2.00,3.06]、抑郁2.15[1.53,3.01]、合并慢性病3.39[2.49,4.62]、糖尿病史1.27[1.11,1.45]、中风史1.47[1.14,1.90]、心脏病1.31[1.13,1.52]、关节炎史1.80[1.48,2.19]、老年痴呆史2.27[1.30,3.97]、应用抗精神病类药物1.90[1.37,2.64]。保护性因素为独立自理0.37[0.29,0.46]。[结论]年龄≥75岁、女性、使用助行器、步态不稳、害怕跌倒、抑郁、合并慢性病、糖尿病史、中风史、心脏病史、关节炎史、老年痴呆史、抗精神病类药物、跌倒史为中国老年人跌倒的危险因素。独立自理是中国老年人跌倒的保护性因素。独居、有配偶、文盲、骨质疏松史、高血压史与中国老年人跌倒无关。因害怕跌倒限制活动、神经系统疾病史、头晕眩晕史、帕金森病史、眼部疾患、视力障碍、直立性低血压、排泄问题、降压药物、降糖药、抗心律失常药物需更多研究进一步证实。

Objective:To determine the risk factors of fall in Chinese elderly through meta analysis.Methods:Case control study,cohort studies and cross sectional studies on risk factors for falls in Chinese elderly published in domestic and international journals byretrieving China Biomedical Literature Database,China Knowledge Network,Wanfang Database,Weipu Chinese Journal Database,PubMed,Ovid,Web of science and CINAHL.The standards compliant literatures were screened and Revman 5.3 software for meta analysis.Results:A total of 23 articles including 5 case control studies,3 cohort studies,and 15 cross sectional studies,with 4 582 cases in the fall group and 19 121 cases in the un fall group.The risk factors and the corresponding OR and 95%CI for the fall of the Chinese elderly were:1.43 in above 75 years old[1.25,1.63],1.43 in women[1.32,1.56],2.39 in using walking aid[2.10,2.73],4.18 in instability of gait[2.72,6.43],2.47 in fear of falling[2.00,3.06],2.15 in depression[1.53,3.01],3.39 in combined chronic disease[2.49,4.62],1.27 in diabetes[1.11,1.45],1.47 in stroke[1.14,1.90],1.31 in heart disease[1.13,1.52],1.80 in arthritis[1.48,2.19],2.27 in senile dementia[1.30,3.97],and 1.90 in antipsychotic drug[1.37,2.64].The protective factor showed 0.37 in independent self care[0.29,0.46].Conclusions:Above 75 years old,female,using the walking aid,gait instability fear of falling,depression,combined with chronic diseases,diabetes,stroke,heart disease,arthritis,senile dementia,antipsychotic drugs and history of falls were the risk factors for the fall of Chinese elderly.Independent self care was the protective factor for the fall of the Chinese elderly.Living alone,having a spouse,illiterate,osteoporosis and high blood pressure had no relation to the fall of the Chinese elderly.Restriction activities due to fear of fall,history of neurological diseases,history of dizziness,dizziness,history of Parkinson′s disease,eye diseases,visual impairment,orthostatic hypotension,excretion problems,antihypertensive drugs,hypoglycemic agents and antiarrhythmic drugs need more research to confirm further.