老年人跌倒评估

≥65 岁的老年人相比年轻人更可能跌倒（OR=2.84 [1.77-4.53]）。[1]Just KS, Dormann H, Schurig M, et al. The phenotype of adverse drug effects: do emergency visits due to adverse drug reactions look different in older people? Results from the ADRED study. Br J Clin Pharmacol. 2020 Nov;86(11):2144-54. https://bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.14304 http://www.ncbi.nlm.nih.gov/pubmed/32250457?tool=bestpractice.com 跌倒往往是多原因的。[2]Deandrea S. Risk factors for falls in community-dwelling older people: a systematic review and meta-analysis. Epidemiology. 2010 Sep;21(5):658-68. http://www.ncbi.nlm.nih.gov/pubmed/20585256?tool=bestpractice.com 对跌倒周围情况和相关症状的识别可以帮助确定基础病因，而这些病因的发现又反过来强调了解跌倒细节的重要性。病因的识别可以决定是否有必要进行更紧急的医学评价，以应对危及生命的病因及其后果。本专题主要侧重于对社区居住老人的跌倒评估。

在全球范围内，1990 年至 2019 年期间，跌倒导致的死亡率有所增加。[3]GBD 2019 Ageing Collaborators. Global, regional, and national burden of diseases and injuries for adults 70 years and older: systematic analysis for the Global Burden of Disease 2019 Study. BMJ. 2022 Mar 10;376:e068208. https://www.doi.org/10.1136/bmj-2021-068208 http://www.ncbi.nlm.nih.gov/pubmed/35273014?tool=bestpractice.com 跌倒是全世界第二大意外伤害致死原因。[4]World Health Organization. Falls. Fact sheets. Apr 2021 [internet publication]. https://www.who.int/news-room/fact-sheets/detail/falls 每年估计有 684,000人死于跌倒，其中 80% 以上来自低中收入国家。[4]World Health Organization. Falls. Fact sheets. Apr 2021 [internet publication]. https://www.who.int/news-room/fact-sheets/detail/falls

在英国，从 2020 年到 2021 年，与 ≥65 岁患者跌倒相关的急诊科入院率超过 2023/100,000，其中 ≥80 岁患者的比率为 5174/100,000。[5]Office for Health Improvement & Disparities. Public health profiles (Counties and UAs from April 2021) [internet publication]. https://fingertips.phe.org.uk/search/falls#page/0/gid/1/pat/6/ati/402/are/E06000015/iid/92732/age/28/sex/4/cat/-1/ctp/-1/yrr/5/cid/4/tbm/1/page-options/ovw-do-0 髋部骨折与 1 年死亡率增加 18%-33% 有关，而且影响日常生活活动，例如购物和行走。[6]Public Health England. Guidance - falls: applying All Our Health. Feb 2022 [internet publication]. https://www.gov.uk/government/publications/falls-applying-all-our-health/falls-applying-all-our-health

在美国，跌倒是 ≥65 岁人群意外伤害致死的主要原因。[7]Burns E, Kakara R. Deaths from falls among persons aged ≥65 years - United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):509-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944976 http://www.ncbi.nlm.nih.gov/pubmed/29746456?tool=bestpractice.com 1/4 的老年人报告每年至少跌倒一次，导致大约 300 万次急诊就诊。2007-2016 年间的数据分析表明，这一发生率每年增加约 3%。[7]Burns E, Kakara R. Deaths from falls among persons aged ≥65 years - United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):509-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944976 http://www.ncbi.nlm.nih.gov/pubmed/29746456?tool=bestpractice.com 几乎所有年龄和人群的跌倒发生均在增加，但 85 岁及以上人群中的增幅最大。该年龄组的跌倒致死率也较高。[7]Burns E, Kakara R. Deaths from falls among persons aged ≥65 years - United States, 2007-2016. MMWR Morb Mortal Wkly Rep. 2018 May 11;67(18):509-14. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5944976 http://www.ncbi.nlm.nih.gov/pubmed/29746456?tool=bestpractice.com