跌倒往往是多原因的。[1]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
以下因素的存在与未来跌倒更大可能性有关，[2]Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006 Sep;90(5):807-24.
http://www.ncbi.nlm.nih.gov/pubmed/16962843?tool=bestpractice.com
[3]McInnes L, Gibbons E, Chandler-Oatts J. Clinical practice guideline for the assessment and prevention of falls in older people. Worldviews Evid Based Nurs. 2005;2(1):33-6.
http://www.ncbi.nlm.nih.gov/pubmed/17040554?tool=bestpractice.com
以及跌倒筛查指南建议识别高危人群的这些特征，这可能有助于实施跌倒预防策略：
运动问题：步态和平衡障碍；肌无力[2]Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006 Sep;90(5):807-24.
http://www.ncbi.nlm.nih.gov/pubmed/16962843?tool=bestpractice.com
[4]Ganz DA, Bao Y, Shekelle PG, et al. Will my patient fall? JAMA. 2007 Jan 3;297(1):77-86.
http://www.ncbi.nlm.nih.gov/pubmed/17200478?tool=bestpractice.com
[5]Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988 Dec 29;319(26):1701-7.
http://www.ncbi.nlm.nih.gov/pubmed/3205267?tool=bestpractice.com
[6]Campbell AJ, Borrie MJ, Spears GF. Risk factors for falls in a community-based prospective study of people 70 years and older. J Gerontol. 1989 Jul;44(4):M112-7.
http://www.ncbi.nlm.nih.gov/pubmed/2738307?tool=bestpractice.com
[7]Chu LW, Chi I, Chiu AY. Incidence and predictors of falls in the Chinese elderly. Ann Acad Med Singapore. 2005 Jan;34(1):60-72.
http://www.annals.edu.sg/pdf200502/ChuW.pdf
http://www.ncbi.nlm.nih.gov/pubmed/15726221?tool=bestpractice.com
[8]Luukinen H, Koski K, Laippala P, et al. Predictors for recurrent falls among the home-dwelling elderly. Scand J Prim Health Care. 1995 Dec;13(4):294-9.
http://www.ncbi.nlm.nih.gov/pubmed/8693215?tool=bestpractice.com
感觉障碍：周围神经病变、前庭功能障碍、视觉障碍[2]Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006 Sep;90(5):807-24.
http://www.ncbi.nlm.nih.gov/pubmed/16962843?tool=bestpractice.com
[4]Ganz DA, Bao Y, Shekelle PG, et al. Will my patient fall? JAMA. 2007 Jan 3;297(1):77-86.
http://www.ncbi.nlm.nih.gov/pubmed/17200478?tool=bestpractice.com
[9]Bergland A, Jarnlo GB, Laake K. Predictors of falls in the elderly by location. Aging Clin Exp Res. 2003 Feb;15(1):43-50.
http://www.ncbi.nlm.nih.gov/pubmed/12841418?tool=bestpractice.com
[10]Pfeiffer E. A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc. 1975 Oct;23(10):433-41.
http://www.ncbi.nlm.nih.gov/pubmed/1159263?tool=bestpractice.com
[11]Coleman AL, Stone K, Ewing SK, et al. Higher risk of multiple falls among elderly women who lose visual acuity. Ophthalmology. 2004 May;111(5):857-62.
http://www.ncbi.nlm.nih.gov/pubmed/15121359?tool=bestpractice.com
认知或情绪障碍：痴呆、抑郁、谵妄[5]Tinetti ME, Speechley M, Ginter SF. Risk factors for falls among elderly persons living in the community. N Engl J Med. 1988 Dec 29;319(26):1701-7.
http://www.ncbi.nlm.nih.gov/pubmed/3205267?tool=bestpractice.com
[7]Chu LW, Chi I, Chiu AY. Incidence and predictors of falls in the Chinese elderly. Ann Acad Med Singapore. 2005 Jan;34(1):60-72.
http://www.annals.edu.sg/pdf200502/ChuW.pdf
http://www.ncbi.nlm.nih.gov/pubmed/15726221?tool=bestpractice.com
体位性低血压[2]Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006 Sep;90(5):807-24.
http://www.ncbi.nlm.nih.gov/pubmed/16962843?tool=bestpractice.com
[4]Ganz DA, Bao Y, Shekelle PG, et al. Will my patient fall? JAMA. 2007 Jan 3;297(1):77-86.
http://www.ncbi.nlm.nih.gov/pubmed/17200478?tool=bestpractice.com
多药联合或某些药物（尤其精神科药物）[12]Hartikainen S, Lonnroos E, Louhivuori K. Medication as a risk factor for falls: critical systematic review. J Gerontol A Biol Sci Med Sci. 2007 Oct;62(10):1172-81.
http://www.ncbi.nlm.nih.gov/pubmed/17921433?tool=bestpractice.com
日常活动能力障碍[13]Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist. 1969 Autumn;9(3):179-86.
http://www.ncbi.nlm.nih.gov/pubmed/5349366?tool=bestpractice.com
环境危害（如松动的地毯、光线不足、杂物堆砌）[2]Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006 Sep;90(5):807-24.
http://www.ncbi.nlm.nih.gov/pubmed/16962843?tool=bestpractice.com
其他因素如年龄或伴发疾病。[2]Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin North Am. 2006 Sep;90(5):807-24.
http://www.ncbi.nlm.nih.gov/pubmed/16962843?tool=bestpractice.com
许多预防跌倒方案的关键内容包括：解除危险因素、提倡运动（包括力量和平衡训练）、审查用药情况、评估视力、评估居所安全性，必要时可进行调整。[14]Centers for Disease Control and Prevention. Home and recreational safety: older adult falls. Feb 2017 [internet publication].
http://www.cdc.gov/homeandrecreationalsafety/falls/adultfalls.html
例如，对于有跌倒高风险的≥65 岁社区居住成人，美国预防服务工作组推荐采用运动（如，成组运动、太极、多元运动）或物理治疗来预防跌倒。[15]US Preventive Services Task Force; Grossman DC, Curry SJ, Owens DK, et al. Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement. JAMA. 2018 Apr 24;319(16):1696-704.
https://jamanetwork.com/journals/jama/fullarticle/2678104
http://www.ncbi.nlm.nih.gov/pubmed/29710141?tool=bestpractice.com
[16]Guirguis-Blake JM, Michael YL, Perdue LA, et al. Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2018 Apr 24;319(16):1705-16.
https://jamanetwork.com/journals/jama/fullarticle/2678103
http://www.ncbi.nlm.nih.gov/pubmed/29710140?tool=bestpractice.com
关于补充维生素 D（单独或搭配钙补充）的荟萃分析显示，该治疗在减少跌倒方面没有益处。[17]Bolland MJ, Grey A, Gamble GD, et al. Vitamin D supplementation and falls: a trial sequential meta-analysis. Lancet Diabetes Endocrinol. 2014 Jul;2(7):573-80.
http://www.ncbi.nlm.nih.gov/pubmed/24768505?tool=bestpractice.com
一项 Cochrane 系统评价发现，与常规治疗或注意力控制相比，多元干预措施（抛开所有对跌倒风险的评估，为所有人提供相同组分干预措施；其中大多数措施包括运动）可以减少生活在社区的老年人跌倒次数和摔倒风险。另外还发现，与常规治疗或注意力控制相比，多因素干预措施（根据对跌倒风险的评估，每个人之间的组分干预措施有所不同）可以减少社区老年人的跌倒次数。[18]Hopewell S, Adedire O, Copsey BJ, et al. Multifactorial and multiple component interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2018 Jul 23;(7):CD012221.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012221.pub2/full
http://www.ncbi.nlm.nih.gov/pubmed/30035305?tool=bestpractice.com
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Can multifactorial interventions help prevent falls among older people living in the community?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2296/full展示答案
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Can multicomponent interventions help prevent falls among older people living in the community?/cca.html?targetUrl=https://www.cochranelibrary.com/cca/doi/10.1002/cca.2295/full展示答案
一项网络荟萃分析发现，以下干预措施在预防导致损伤的跌倒方面比常规治疗更有效：[19]Tricco AC, Thomas SM, Veroniki AA, et al. Comparisons of Interventions for Preventing Falls in Older Adults: A Systematic Review and Meta-analysis. JAMA. 2017 Nov 7;318(17):1687-99
http://www.ncbi.nlm.nih.gov/pubmed/29114830?tool=bestpractice.com
若干指南已对采用此类干预措施预防跌倒进行评估：
跌倒是美国≥65 岁人群由意外伤害导致死亡的主要原因。[20]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
四分之一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。从 2007 年到 2016 年收集的数据表明，这一发生率每年增加约 3%。[20]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 岁及以上人群的增幅最大。该年龄组的跌倒致死率也较高。[20]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
对跌倒周围情况和相关症状的识别可以帮助确定潜在病因，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多的紧急的医学评价，以应对危及生命的病因及其后果。 这个调查也可以帮助识别最有可能导致跌倒的危险因素，实施适当的干预措施来减少再次跌倒的风险。
