Medicína pro praxi, Год журнала: 2025, Номер 22(1), С. 10 - 14
Опубликована: Фев. 20, 2025
Язык: Английский
Age and Ageing, Год журнала: 2022, Номер 51(9)
Опубликована: Сен. 1, 2022
falls and fall-related injuries are common in older adults, have negative effects on functional independence quality of life associated with increased morbidity, mortality health related costs. Current guidelines inconsistent, no up-to-date, globally applicable ones present.
Язык: Английский
Процитировано
768
JAMA Network Open, Год журнала: 2021, Номер 4(12), С. e2138911 - e2138911
Опубликована: Дек. 15, 2021
Importance With the global population aging, falls and fall-related injuries are ubiquitous, several clinical practice guidelines for prevention management individuals 60 years or older have been developed. A systematic evaluation of recommendations agreement level is lacking. Objectives To perform a review adults in all settings (eg, community, acute care, nursing homes), evaluate recommendations, identify potential gaps. Evidence Review following Preferred Reporting Items Systematic Reviews Meta-analyses statement methods on fall was conducted (updated July 1, 2021) using MEDLINE, PubMed, PsycINFO, Embase, CINAHL, Cochrane Library, PEDro, Epistemonikos databases. Medical Subject Headings search terms were related to falls, guidelines, prevention, adults, with no restrictions date, language, setting inclusion. Three independent reviewers selected records full-text examination if they followed evidence- consensus-based processes assessed quality Appraisal Guidelines Research & Evaluation II (AGREE-II) criteria. The strength evaluated Grades Recommendation, Assessment, Development, scores, across topic areas Fleiss κ statistic. Findings Of 11 414 identified, 159 fully reviewed eligibility, 15 included. All had high-quality AGREE-II total scores (mean [SD], 80.1% [5.6%]), although individual domain applicability 63.4% [11.4%]) stakeholder (clinicians, patients, caregivers) involvement 76.3% [9.0%]) lower. 198 covering 16 identified after screening 4767 abstracts that proceeded full texts. Most (≥11) strongly recommended performing risk stratification, assessment tests gait balance, fracture osteoporosis management, multifactorial interventions, medication review, exercise promotion, environment modification, vision footwear correction, referral physiotherapy, cardiovascular interventions. strengths inconsistent vitamin D supplementation, addressing cognitive factors, education. Recommendations use hip protectors digital technology wearables often missing. None examined included patient caregiver panel their deliberations. Conclusions Relevance This found current showed high degree which strong made, whereas other did not achieve this consensus coverage. Future should address include perspectives patients stakeholders.
Язык: Английский
Процитировано
206
JAMA, Год журнала: 2024, Номер 331(16), С. 1397 - 1397
Опубликована: Март 27, 2024
Importance Falls are reported by more than 14 million US adults aged 65 years or older annually and can result in substantial morbidity, mortality, health care expenditures. Observations from age-related physiologic changes compounded multiple intrinsic extrinsic risk factors. Major modifiable factors among community-dwelling include gait balance disorders, orthostatic hypotension, sensory impairment, medications, environmental hazards. Guidelines recommend that individuals who report a fall the prior year, have concerns about falling, speed less 0.8 to 1 m/s should receive prevention interventions. In meta-analysis of 59 randomized clinical trials (RCTs) average-risk high-risk populations, exercise interventions reduce falls were associated with 655 per 1000 patient-years intervention groups vs 850 nonexercise control (rate ratio [RR] for falls, 0.77; 95% CI, 0.71-0.83; number people fall, 0.85; 0.81-0.89; difference, 7.2%; 5.2%-9.1%), most assessing functional exercises. 43 RCTs systematically assessed addressed at high risk, multifactorial 1784 2317 (RR, 0.67-0.87) without significant difference fell. Other decreased quasi-randomized surgery remove cataracts (8 studies 1834 patients; [RR], 0.68; 0.48-0.96), multicomponent podiatry (3 1358 RR, 0.61-0.99), modifications (12 5293 0.74; 0.61-0.91). Meta-analysis programs stop medications not found reduction, although deprescribing is component many successful Conclusions Relevance More 25% each leading cause injury-related death persons older. Functional exercises improve leg strength recommended populations. Multifactorial reduction based on systematic assessment may rates those risk.
Язык: Английский
Процитировано
34
Age and Ageing, Год журнала: 2021, Номер 50(5), С. 1499 - 1507
Опубликована: Апрель 24, 2021
Abstract Background falls and fall-related injuries are common in older adults, have negative effects both on quality of life functional independence associated with increased morbidity, mortality health care costs. Current clinical approaches advice from guidelines vary substantially between countries settings, warranting a standardised approach. At the first World Congress Falls Postural Instability Kuala Lumpur, Malaysia, December 2019, worldwide task force experts committed to achieving global consensus updating practice for prevention management by incorporating current emerging evidence research. Moreover, importance taking person-centred approach including perspectives patients, caregivers other stakeholders was recognised as important components this endeavour. Finally, need specifically include recent developments e-health acknowledged, well addressing differences settings developing countries. Methods steering committee assembled 10 working Groups were created provide preliminary evidence-based recommendations. A cross-cutting theme patient’s perspective also created. In addition, multidisciplinary group stakeholders, review proposed recommendations participate Delphi process achieve final recommendations, brought together. Conclusion New Horizons article, challenges depicted, goals summarised conceptual framework development guideline is presented.
Язык: Английский
Процитировано
76
European Geriatric Medicine, Год журнала: 2021, Номер 12(3), С. 585 - 596
Опубликована: Март 15, 2021
The aim of this clinical review was to summarize the existing knowledge on fall risk associated with antidepressant use in older adults, describe underlying mechanisms, and assist clinicians decision-making regard (de-) prescribing antidepressants persons.
Язык: Английский
Процитировано
73
BMC Geriatrics, Год журнала: 2025, Номер 25(1)
Опубликована: Янв. 21, 2025
Fall-prevention interventions are efficient but resource-requiring and should target persons at higher risk of falls. We need to ensure that fall is systematically assessed in everyday practice. conducted a quality improvement (QI) intervention systematize assessment prevention older adults hospitalized on general internal medicine wards. evaluated the efficacy pre-post study its feasibility acceptability through mixed methods process evaluation, which results reported here. The QI was between 09/2022 10/2023 targeted nursing staff residents two tertiary hospitals different language cultural regions Switzerland. comprised an oral presentation, e-learning, reminder quizzes. evaluation including 25 interviews survey sent all participants assess intervention. Quantitative data were analyzed descriptively qualitative with deductive inductive approach. Results integrated meta-inferences. Among 544 clinicians, 59% completed 74% found useful, 25% increase interprofessional team working. A rewarding system deemed motivating by 33% clinicians. Main implementation barrier high workload. concise clear content as well regular reminders perceived facilitators. multimodal seemed be feasible well-accepted. Future projects consider barriers facilitators identified this project improve care adults. research not pre-registered.
Язык: Английский
Процитировано
1
Drug Safety, Год журнала: 2025, Номер unknown
Опубликована: Фев. 11, 2025
Язык: Английский
Процитировано
1
Drugs & Aging, Год журнала: 2022, Номер 39(3), С. 199 - 207
Опубликована: Март 1, 2022
Pain treatment is important in older adults but may result adverse events such as falls. Opioids are effective for nociceptive pain the evidence neuropathic weak. Nevertheless, both and opioids increase risk of This narrative literature review aims to summarize existing knowledge on opioid-related fall adults, including pharmacokinetics pharmacodynamics, assist clinicians prescribing deprescribing persons. We systematically searched relevant PubMed Scopus December 2020. reviewed evaluated fall-related effects opioids, explaining how optimally approach adults. Opioid use increases through drowsiness, (orthostatic) hypotension also hyponatremia caused by weak opioids. When prescribing, should be started with low dosages if possible, keeping mind their metabolic genetic variation. Falls clinically significant all dose dependent highest strong The most prominent prone To reduce falls, need assessed a regular basis, or changing lower dosage safer alternative considered clinical condition allows. Deprescribing done reducing gradually assessing monitoring withdrawal symptoms at same time. Weighing risks benefits necessary before especially persons high Clinical decision tools prescribers decisions regarding (de-) prescribing.
Язык: Английский
Процитировано
35
European Geriatric Medicine, Год журнала: 2022, Номер 13(3), С. 513 - 528
Опубликована: Янв. 1, 2022
Abstract Purpose The world’s population is ageing. Therefore, every doctor should receive geriatric medicine training during their undergraduate education. This review aims to summarise recent developments in that will potentially inform and updating of medical curricula for content. Methods We systematically searched the electronic databases Ovid Medline, Embase Pubmed, from 1st January 2009 18th May 2021. included studies related (1) students (2) or ageing older adults (3) curriculum topics learning objectives competencies teaching methods students’ attitudes (4) published a scientific journal. No language restrictions were applied. Results identified 2503 records assessed full texts 393 eligibility with 367 thematic analysis. Six major themes emerged: curriculum, topics, methods, settings, skills attitudes. New focussed on minimum Geriatrics Competencies, Geriatric Psychiatry Comprehensive Assessment; vertical integration Medicine into has been advocated. Emerging evolving delirium, pharmacotherapeutics, healthy health promotion, Telemedicine. Teaching emphasised interprofessional education, senior mentor programmes intergenerational contact, student journaling reflective writing, simulation, clinical placements e-learning. Nursing homes featured among new settings. Communication skills, empathy professionalism highlighted as essential interacting adults. Conclusion recommend future take account described this paper. In addition including newly emerged advances existing different settings also be considered. Employing throughout course can usefully supplement achieved dedicated course. Interprofessional education improve understanding roles other professionals team-working skills. A focus improving communication particularly enable better interaction patients. Embedding expected levels ensure have acquired necessary effectively treat
Язык: Английский
Процитировано
31
European Geriatric Medicine, Год журнала: 2022, Номер 14(4), С. 697 - 708
Опубликована: Дек. 28, 2022
Abstract Purpose The aim of this clinical review was to summarise the existing knowledge on fall risk associated with benzodiazepines (BZDs) and Z-drugs in older people focus appropriate prescribing, including deprescribing. Methods We conducted a literature search June 2021 PubMed Embase citation reference checking. Personal libraries international websites were also used. Keywords for searches included “benzodiazepines”, “Z-drugs”, “falls”, “deprescribing”, “fall-risk-increasing-drugs”, “inappropriate prescribing”, “older people” matching synonyms. discuss use BZDs Z-drugs, potential fall-related adverse reactions, alternatives deprescribing persons. Results differ effect profile. They contribute through orthostatic hypotension, dizziness and/or imbalance, sedation, muscular weakness, ataxia, etc. Fall incidents significantly mortality morbidity. Therefore, there is need prescribing people. In practice, means pertaining strict indication, strongly consider non-pharmacological alternatives, limit lowest dose shortest duration possible. Judicious should be considered encouraged as well. Practical resources, tools algorithms are available guide assist clinicians Z-drugs. Conclusions Prescribing done well-considered way fall-prone A good overview insight effects these drugs, well availability different strategies increase use, initiatives, can decision-making.
Язык: Английский
Процитировано
28