Interpretation of the 2022 World Guidelines for Falls Prevention and Management for Older Adults: a Global Initiative

doi:10.12114/j.issn.1007-9572.2022.0842

Chinese General Practice ›› 2023, Vol. 26 ›› Issue (10): 1159-1163.DOI: 10.12114/j.issn.1007-9572.2022.0842

Special Issue: 指南/共识最新文章合辑；跌倒最新文章合辑；老年问题最新文章合辑

• Guideline Interpretation • Next Articles

Interpretation of the 2022 World Guidelines for Falls Prevention and Management for Older Adults: a Global Initiative

1. School of Nursing, Nanjing Medical University, Nanjing 211166, China
2. Department of Orthopedics, the First Affiliated Hospital with Nanjing Medical University, Nanjing 210029, China
3. School of Nursing, University of Texas Health San Antonio, San Antonio 78229, USA
4. School of Nursing, University of Mississippi Medical Center, Jackson 39216, USA
5. School of Nursing, Southern Medical University, Guangzhou 510515, China

Received:2022-12-02 Revised:2023-01-10 Published:2023-04-05 Online:2023-01-18
Contact: YANG Rumei, DING Yaping
About author:
WU Y, WANG G L, NIE Z T, et al. Interpretation of the 2022 World Guidelines for Falls Prevention and Management for Older Adults: a Global Initiative [J]. Chinese General Practice, 2023, 26 (10): 1159-1163, 1171.

2022年版《世界指南：老年人跌倒的预防与管理》解读

1．211166　江苏省南京市，南京医科大学护理学院
2．210029　江苏省南京市，南京医科大学第一附属医院骨科
3．78229　美国圣安东尼奥市，德克萨斯州圣安东尼奥分校护理学院
4．39216　美国杰克逊市，密西西比大学医学中心护理学院
5．510515　广东省广州市，南方医科大学护理学院

通讯作者: 杨如美, 丁亚萍
作者简介:
吴延，王广玲，聂作婷，等. 2022年版《世界指南：老年人跌倒的预防与管理》解读[J].中国全科医学，2023，26（10）：1159-1163，1171.[www.chinagp.net]
作者贡献：吴延负责论文构思与设计，参与论文相关资料收集和论文撰写与修订；王广玲和聂作婷参与论文相关资料收集、论文撰写与修订；梁玮、杜艳、李青、曾凯、陈龙、高诗瀛和陶璐负责论文撰写与修订；杨如美和丁亚萍参与质量控制与审校，并对文章整体负责、监督管理。
基金资助:
国家自然科学基金资助项目(72004098); 2020年度江苏高校哲学社会科学研究一般项目(2020SJA0302); 南京医科大学研究生优质教育资源建设项目(2021F005); 江苏高校优势学科建设工程项目"护理学"(苏政办发〔2018〕87号); "十四五"高等教育科学研究规划课题(苏高教会〔2021〕16号YB009)

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Abstract

Abstract:

As China enters a deep aging society, falls and fall-related injuries in older adults have gained increased attention, with increasing emergence of relevant studies, and continuous updates in relevant guidelines. In 2022, The World Falls Task Force assembled 96 experts from 39 countries to develop the World Guidelines for Falls Prevention and Management for Older Adults: a Global Initiative. The guidelines were developed using the person-centered methodology and the latest evidence on e-health for the prevention of falls, with full consideration of the needs of fall management of older adults, and their caregivers and other stakeholders' perspectives on preventing falls in older adults, as well as the guideline applicability in various care settings and locations with limited resources, which provide new clinical recommendations on the screening, assessment, and management of risk for falls among community-dwelling older adults. This paper offers an in-depth interpretation of the guidelines and an analysis of the effective practical guidance in the guidelines, providing practical guidance for Chinese physicians, nurses and community health workers to prevent and manage falls in older adults.

Key words: Falls, Aged, Injury, Prevention, Management, Guidelines, Interpretation

摘要：

随着我国迈入深度老龄化社会，老年人跌倒和跌倒相关伤害问题受到广泛关注，国内外相关研究和指南不断更新。来自39个国家、96位专家组成的世界跌倒预防指南小组于2022年制定了《世界指南：老年人跌倒的预防与管理》。该指南着眼于"以人为本"的理念，充分考虑老年人的跌倒管理需求及照顾者和其他利益相关方对跌倒的看法，并考虑指南在各照护环境和资源有限地区的适用性，结合应用电子健康进行跌倒预防的前沿证据，针对社区老年人的跌倒风险初筛、跌倒风险评估、跌倒风险分级管理提供新的实践指导建议。本文将深入解读该指南，提取该指南中行之有效的实践指导建议进行分析，为我国的医护工作者和社区卫生工作者预防和管理老年人跌倒提供参考。

关键词: 跌倒, 老年人, 伤害, 预防, 管理, 指南, 解读

WU Yan,WANG Guangling,NIE Zuoting, et al. Interpretation of the 2022 World Guidelines for Falls Prevention and Management for Older Adults: a Global Initiative[J]. Chinese General Practice, 2023, 26(10): 1159-1163. DOI: 10.12114/j.issn.1007-9572.2022.0842.
吴延,王广玲,聂作婷等. 2022年版《世界指南：老年人跌倒的预防与管理》解读[J]. 中国全科医学, 2023, 26(10): 1159-1163. DOI: 10.12114/j.issn.1007-9572.2022.0842.

Figures/Tables 3

References 18

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[3]	SARMIENTO K, LEE R. STEADI：CDC's approach to make older adult fall prevention part of every primary care practice[J]. J Safety Res，2017，63:105-109. DOI：10.1016/j.jsr.2017.08.003.
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[5]	MONTERO-ODASSO M, VAN DER VELDE N, MARTIN F C，et al. World guidelines for falls prevention and management for older adults：a global initiative[J]. Age Ageing，2022，51(9):afac205. DOI：10.1093/ageing/afac205.
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[8]	Panel on Prevention of Falls in Older Persons, American Geriatrics Society and British Geriatrics Society. Summary of the Updated American Geriatrics Society/British Geriatrics Society clinical practice guideline for prevention of falls in older persons[J]. J Am Geriatr Soc，2011，59(1):148-157. DOI：10.1111/j.1532-5415.2010.03234.x.
[9]	DENT E, MORLEY J E, CRUZ-JENTOFT A J，et al. Physical frailty：ICFSR international clinical practice guidelines for identification and management[J]. J Nutr Health Aging，2019，23(9):771-787. DOI：10.1007/s12603-019-1273-z.
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[14]	GANZ D A, LATHAM N K. Prevention of falls in community-dwelling older adults[J]. N Engl J Med，2020，382(8):734-743. DOI：10.1056/NEJMcp1903252.
[15]	LAMB S E, MCCABE C, BECKER C，et al. The optimal sequence and selection of screening test items to predict fall risk in older disabled women：the Women's Health and Aging Study[J]. J Gerontol A Biol Sci Med Sci，2008，63(10):1082-1088.
[16]	SHERRINGTON C, FAIRHALL N, KWOK W，et al. Evidence on physical activity and falls prevention for people aged 65+ years：systematic review to inform the WHO guidelines on physical activity and sedentary behaviour[J]. Int J Behav Nutr Phys Act，2020，17(1):144. DOI：10.1186/s12966-020-01041-3.
[17]	World Health Organization.WHO guidelines on physical activity and sedentary behaviour[EB/OL].（2020-02-14）[2022-11-09].
[18]	中国疾病预防控制中心慢性非传染性疾病预防控制中心.慢病中心组织完成《社区老年人跌倒预防控制技术指南》编写[EB/OL].（2021-12-29）[2022-12-19].

评估模块	推荐意见	证据等级
步态与平衡能力评估	将步态和平衡能力纳入多因素跌倒风险评估	1B
认知评估	将认知状况纳入多因素跌倒风险评估	1B
	为认知障碍老年人制定跌倒预防计划时，应考虑其和照顾者的观点，以提高预防干预的依从性	1C
视力和听力评估	询问是否有视力障碍，测视力和必要时测量其他视力问题（如偏盲）	E
视力和听力评估	询问是否有听力障碍，测听力和必要时咨询专家	E
心血管评估	评估心血管状况（包括心脏病史，听诊、卧位和站位血压，12导联体表心电图）	1B
	若首次心血管评估正常，则无须进一步的心血管评估，除非怀疑晕厥（如反复出现原因不明的跌倒）	1A
头晕和前庭神经疾病的评估	定期询问老年人头晕症状，必要时对其进行随访评估以明确心血管和或前庭神经系统的病因	E
疼痛评估	将疼痛情况纳入多因素跌倒风险评估，必要时可进行全面的疼痛评估	E
跌倒担忧评估	将跌倒担忧纳入多因素跌倒风险评估	1B
跌倒担忧评估	采用标准化的工具评估社区老年人的跌倒担忧，如国际跌倒效能量表（Falls Efficacy Scale International，FES-Ⅰ）或简明国际版跌倒效能量表（Short Falls Efficacy Scale International，Short FES-Ⅰ）	1A
	采用FES-Ⅰ，特别是Short FES-Ⅰ，评估急诊科老年人和养老机构老年人的跌倒担忧	1B
药物评估	加强药物管理，为老年人开可能增加跌倒风险药物（fall risk increasing drugs，FRIDs）处方之前，应评估其跌倒史和跌倒风险	1B
	进行药物审查或针对老年人跌倒预防的药物审查时，可使用标准化的筛查工具来确定FRIDs	1C
环境评估	由经过培训的医护工作者评估老年人居住环境中的跌倒风险因素及老年人处理和应对该环境危险因素的相应行为和能力	1B
尿路症状评估	将尿路症状纳入多因素跌倒风险评估	E
抑郁评估	将抑郁纳入多因素跌倒风险评估，必要时进一步评估精神状态，如有需要请相关专家介入	E
营养评估（包括维生素D）	评估营养状况（包括维生素D的摄入量），必要时适当补充营养	E
老年人跌倒观点评估	将老年人对跌倒原因、风险和预防的看法纳入多因素跌倒风险评估	1B

评估模块	推荐意见	证据等级
步态与平衡能力评估	将步态和平衡能力纳入多因素跌倒风险评估	1B
认知评估	将认知状况纳入多因素跌倒风险评估	1B
	为认知障碍老年人制定跌倒预防计划时，应考虑其和照顾者的观点，以提高预防干预的依从性	1C
视力和听力评估	询问是否有视力障碍，测视力和必要时测量其他视力问题（如偏盲）	E
视力和听力评估	询问是否有听力障碍，测听力和必要时咨询专家	E
心血管评估	评估心血管状况（包括心脏病史，听诊、卧位和站位血压，12导联体表心电图）	1B
	若首次心血管评估正常，则无须进一步的心血管评估，除非怀疑晕厥（如反复出现原因不明的跌倒）	1A
头晕和前庭神经疾病的评估	定期询问老年人头晕症状，必要时对其进行随访评估以明确心血管和或前庭神经系统的病因	E
疼痛评估	将疼痛情况纳入多因素跌倒风险评估，必要时可进行全面的疼痛评估	E
跌倒担忧评估	将跌倒担忧纳入多因素跌倒风险评估	1B
跌倒担忧评估	采用标准化的工具评估社区老年人的跌倒担忧，如国际跌倒效能量表（Falls Efficacy Scale International，FES-Ⅰ）或简明国际版跌倒效能量表（Short Falls Efficacy Scale International，Short FES-Ⅰ）	1A
	采用FES-Ⅰ，特别是Short FES-Ⅰ，评估急诊科老年人和养老机构老年人的跌倒担忧	1B
药物评估	加强药物管理，为老年人开可能增加跌倒风险药物（fall risk increasing drugs，FRIDs）处方之前，应评估其跌倒史和跌倒风险	1B
	进行药物审查或针对老年人跌倒预防的药物审查时，可使用标准化的筛查工具来确定FRIDs	1C
环境评估	由经过培训的医护工作者评估老年人居住环境中的跌倒风险因素及老年人处理和应对该环境危险因素的相应行为和能力	1B
尿路症状评估	将尿路症状纳入多因素跌倒风险评估	E
抑郁评估	将抑郁纳入多因素跌倒风险评估，必要时进一步评估精神状态，如有需要请相关专家介入	E
营养评估（包括维生素D）	评估营养状况（包括维生素D的摄入量），必要时适当补充营养	E
老年人跌倒观点评估	将老年人对跌倒原因、风险和预防的看法纳入多因素跌倒风险评估	1B

干预模块	推荐意见	证据等级
身体活动和锻炼干预	所有社区老年人进行预防跌倒的运动计划，运动类型包括平衡功能锻炼（如坐立训练、踏步走）等，频率为每周≥3次，持续时间超过12周，以取得较好的长期效应	1A
	在可行的情况下，加入太极和额外的渐进性抗阻力量训练	1B
	帕金森及其相关功能障碍：为有轻度或无认知障碍的早或中期帕金森患者制定包括平衡和抗阻训练在内的个性化锻炼方案	1A
	脑卒中：为脑卒中老年人提供针对改善平衡、力量或行走能力的运动方案	2C
	轻度认知障碍和痴呆：对有认知障碍（轻度认知功能障碍和轻中度痴呆）的社区老年人进行运动干预，主要包括平衡训练和多组分运动，如太极拳和抗阻加平衡训练	1B
	髋部骨折：为髋部骨折的老年人制定个性化和渐进性运动方案以改善活动能力	1B
	髋部骨折老年人在社区持续执行运动方案	1A
药物干预	将药物审查和适当减少FRIDs纳入多因素跌倒预防干预措施	1B
心血管干预	将直立性低血压的管理纳入多因素跌倒预防干预措施	1A
远程医疗和技术干预	在可行的情况下，将远程医疗、智能家庭系统联合运动训练作为社区老年人跌倒预防干预的一部分	E
	目前研究证据尚不足以证明使用可穿戴设备可预防跌倒，但当可穿戴设备被用于运动项目以防止跌倒时，其可能会增加患者的参与度	1C
生活环境干预	根据老年人能力及行为，经过训练的临床医生应对其家庭环境中可导致老年人有跌倒危险的部分提出调整建议	1B
针对前庭神经疾病、疼痛和视力的干预	将前庭神经疾病管理、疼痛治疗和视力障碍管理纳入多因素风险管理	E
对跌倒担忧的干预	为老年人提供运动锻炼方案、认知行为疗法、职业疗法以缓解其跌倒担忧	1B

干预模块	推荐意见	证据等级
身体活动和锻炼干预	所有社区老年人进行预防跌倒的运动计划，运动类型包括平衡功能锻炼（如坐立训练、踏步走）等，频率为每周≥3次，持续时间超过12周，以取得较好的长期效应	1A
	在可行的情况下，加入太极和额外的渐进性抗阻力量训练	1B
	帕金森及其相关功能障碍：为有轻度或无认知障碍的早或中期帕金森患者制定包括平衡和抗阻训练在内的个性化锻炼方案	1A
	脑卒中：为脑卒中老年人提供针对改善平衡、力量或行走能力的运动方案	2C
	轻度认知障碍和痴呆：对有认知障碍（轻度认知功能障碍和轻中度痴呆）的社区老年人进行运动干预，主要包括平衡训练和多组分运动，如太极拳和抗阻加平衡训练	1B
	髋部骨折：为髋部骨折的老年人制定个性化和渐进性运动方案以改善活动能力	1B
	髋部骨折老年人在社区持续执行运动方案	1A
药物干预	将药物审查和适当减少FRIDs纳入多因素跌倒预防干预措施	1B
心血管干预	将直立性低血压的管理纳入多因素跌倒预防干预措施	1A
远程医疗和技术干预	在可行的情况下，将远程医疗、智能家庭系统联合运动训练作为社区老年人跌倒预防干预的一部分	E
	目前研究证据尚不足以证明使用可穿戴设备可预防跌倒，但当可穿戴设备被用于运动项目以防止跌倒时，其可能会增加患者的参与度	1C
生活环境干预	根据老年人能力及行为，经过训练的临床医生应对其家庭环境中可导致老年人有跌倒危险的部分提出调整建议	1B
针对前庭神经疾病、疼痛和视力的干预	将前庭神经疾病管理、疼痛治疗和视力障碍管理纳入多因素风险管理	E
对跌倒担忧的干预	为老年人提供运动锻炼方案、认知行为疗法、职业疗法以缓解其跌倒担忧	1B

Interpretation of the 2022 World Guidelines for Falls Prevention and Management for Older Adults: a Global Initiative

2022年版《世界指南：老年人跌倒的预防与管理》解读

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[2]	LI Ling, LI Yaping, QIAN Shixing, NIE Jing, LU Chunhua, LI Xia. Research on Influencing Factors and Risk Prediction of Cognitive Function in Community-dwelling Middle-aged and Elderly People [J]. Chinese General Practice, 2025, 28(30): 3773-3778.
[3]	XU Jialan, YAN Hong, WEN Jun, ZHOU Zitong, WANG Siyu. Prevalence of Potentially Inappropriate Medication in Older Adults with Cancer: a Meta-analysis [J]. Chinese General Practice, 2025, 28(30): 3815-3822.
[4]	ZHANG Peng, LIU Lidi, ZHANG Ying, YANG Ziyu, LIU Changming, TANG Yijun, LIAO Xiaoyang, JIA Yu. Interpretation and Clinical Implications of the 2024 Italian Guidelines for the Management of Adult Individuals with Overweight and Obesity and Metabolic Comorbidities That are Resistant to Behavioral Treatment [J]. Chinese General Practice, 2025, 28(30): 3747-3752.
[5]	XIANG Xinyue, ZHANG Bingqing, OUYANG Yuqin, TANG Wenjuan, FENG Wenhuan. Impact of Short-term Medical Weight Loss on Atherosclerotic Cardiovascular Disease Risk in Patients with Obesity [J]. Chinese General Practice, 2025, 28(26): 3229-3239.
[6]	CHEN Junyu, HAN Guangli, LI Chunhong, CHEN Yidi, YANG Nana, LUO Xiaoxi. Classification Study of Self-management Types among Pregnant Women in Rural Areas Based on Cluster Analysis [J]. Chinese General Practice, 2025, 28(26): 3289-3293.
[7]	YAN Fanghong, PENG Guotian, ZHANG Guoli, SUN Ruiyi, MA Yuxia, HAN Lin. Matching Analysis of the Content of Chronic Disease Management for the Elderly in Medical Union: Based on the Perspective of "Guidance-Practice-Need" [J]. Chinese General Practice, 2025, 28(25): 3119-3126.
[8]	TANG Shangfeng, HUANG Yangzhen, ZHENG Yanxi, PAN Yangyang, XIONG Zhongbao, QING Hua, SONG Jia, WEI Yilin, DONG Heng, WANG Chunying, CHEN Manwei, ZHANG Kangkang. Specification for the Integration of Healthcare and Prevention Services in Diabetes at the Primary Level [J]. Chinese General Practice, 2025, 28(25): 3096-3103.
[9]	TANG Shangfeng, HUANG Yangzhen, PAN Yangyang, ZHENG Yanxi, XIONG Zhongbao, ZHANG Kangkang, SONG Jia, WEI Yilin, WANG Chunying, DONG Heng, CHEN Manwei, QING Hua. Specification for the Integration of Healthcare and Prevention Services in Hypertension at the Primary Level [J]. Chinese General Practice, 2025, 28(25): 3089-3095.
[10]	YU Zizi, LIU Duli, LI Ximin, RUAN Chunyi, YIN Xiangyang, CAI Le. Analysis of the Prevalence and Self-management of Hypertension and Its Influencing Factors in Rural [J]. Chinese General Practice, 2025, 28(25): 3137-3143.
[11]	LI Jiaxin, LIU Zhonghui, XIE Shuo, FU Zhifang, SUN Dan, JIAO Hongmei. Trajectory in Biomarkers of Metabolic and Inflammatory States as Early Predictors of Chronic Critical Illness in Aging Patients [J]. Chinese General Practice, 2025, 28(24): 2993-2999.
[12]	HE Jinyu, ZHULIDUZI Jiesisibieke, ZHANG Ning, LIU Min, LIANG Wannian. Research on Blood Pressure Control and Its Determinants Among Hypertensive Patients Under Standardized Management in China: Status, Challenges, and Future Directions [J]. Chinese General Practice, 2025, 28(24): 2968-2971.
[13]	YANG Chen, CHEN Tong, ZHANG Lifang, ZHANG Hongxu, LI Pengfei, ZHANG Xuejuan. Prognostic Impact of Dapagliflozin in Elderly Breast Cancer Survivors with Heart Failure with Preserved Ejection Fraction and Type 2 Diabetes [J]. Chinese General Practice, 2025, 28(24): 3053-3058.
[14]	YU Wenhua, LI Jianguo, DUAN Wenyan, GAO Xuyan, LI Xiaxia, ZHANG Zilong, ZHANG Li, MA Lina. Reliability and Validity of the Function Impairment Screening Tool among Community-dwelling Older Adults [J]. Chinese General Practice, 2025, 28(24): 3000-3004.
[15]	BAI Xue, CHEN Qianqian, LI Jie. Innovative Practices in Chronic Disease Management: a New Model for Generalist-Specialist Combination Management of Diabetes and Metabolic Dysfunction-associated Fatty Liver Disease [J]. Chinese General Practice, 2025, 28(23): 2841-2845.