失能老人及残障人群如厕跌倒多学科综合干预路径专家共识

王毅, 靖华芳, 吴鹏杰, 白云静, 李雯, 张帆, 张学敏, 王建龙, 刘正奎, 廖利民, 袁清

武警医学 ›› 2026, Vol. 37 ›› Issue (8) : 645-654.

PDF(1219 KB)
PDF(1219 KB)
武警医学 ›› 2026, Vol. 37 ›› Issue (8) : 645-654. DOI: 10.3969/j.issn.1004-3594.2026.08.001
专家共识

失能老人及残障人群如厕跌倒多学科综合干预路径专家共识

  • 王毅1, 靖华芳2, 吴鹏杰3, 白云静4, 李雯2, 张帆2, 张学敏5, 王建龙3, 刘正奎4, 廖利民2, 袁清1
作者信息 +
文章历史 +

摘要

如厕跌倒是失能老人及残障人群伤残和死亡的重要危险因素,目前国内缺乏系统防控体系。编写组基于循证医学证据,构建适用于医院、养老机构、社区及家庭的如厕跌倒防控路径。明确五大跌倒触发因素,从排尿、运动、心理、环境四个维度开展风险评估,按危险程度实施分层干预,干预措施涵盖运动康复、环境改造、下尿路疾病诊治、用药优化、心理干预、教育培训和辅助技术。旨在为失能老人及残障人群如厕跌倒的早期识别、精准防控提供参考。

关键词

如厕跌倒 / 失能老人 / 残障人群 / 跌倒预防 / 防控路径

引用本文

导出引用
王毅, 靖华芳, 吴鹏杰, 白云静, 李雯, 张帆, 张学敏, 王建龙, 刘正奎, 廖利民, 袁清. 失能老人及残障人群如厕跌倒多学科综合干预路径专家共识[J]. 武警医学. 2026, 37(8): 645-654 https://doi.org/10.3969/j.issn.1004-3594.2026.08.001
中图分类号: R694.5   

参考文献

[1] World Health Organization. WHO global report on falls prevention in older age[R/OL]. 2008-03-17. https://www.who.int/publications/i/item/9789241563536.
[2] World Health Organization. Falls[EB/OL]. (2021-04-26)[2026-06-05]. https://www.who.int/news-room/fact-sheets/detail/falls.
[3] 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.
[4] US Preventive Services Task Force, Nicholson W K, Silverstein M, et al. Interventions to prevent falls in community-dwelling older adults: US Preventive Services Task Force recommendation statement[J]. JAMA, 2024, 332(1): 51-57.
[5] Guirguis-Blake J M, Perdue L A, Coppola E L, et al. Interventions to prevent falls in older adults: updated evidence report and systematic review for the US Preventive Services Task Force[J]. JAMA, 2024, 332(1): 58-69.
[6] Colón-Emeric C S, McDermott C L, Lee D S, et al. Risk assessment and prevention of falls in older community-dwelling adults: a review[J]. JAMA, 2024, 331(16): 1397-1406.
[7] Rose G, Decalf V, Everaert K, et al. Toileting-related falls at night in hospitalised patients: the role of nocturia[J]. Australas J Ageing, 2020, 39(1): e70-e76.
[8] Decalf V, Bower W, Rose G, et al. Prevalence and characteristics of incident falls related to nocturnal toileting in hospitalized patients[J]. Acta Clin Belg, 2021, 76(2): 85-90.
[9] National Institute for Health and Care Excellence. Falls: assessment and prevention in older people and in people 50 and over at higher risk[EB/OL]. (2025-04-29)[2026-06-05]. https://www.nice.org.uk/guidance/ng249.
[10] Pesonen J S, Vernooij R W M, Cartwright R, et al. The impact of nocturia on falls and fractures: a systematic review and meta-analysis[J]. J Urol, 2020, 203(4): 674-683.
[11] Roggeman S, Weiss J P, Van Laecke E, et al. The role of lower urinary tract symptoms in fall risk assessment tools in hospitals: a review[J]. F1000Res, 2020, 9: 236.
[12] Hashim H, Blanker M H, Drake M J, et al. International Continence Society report on the terminology for nocturia and nocturnal lower urinary tract function[J]. Neurourol Urodyn, 2019, 38(2): 499-508.
[13] Lukacz E S, Santiago-Lastra Y, Albo M E, et al. Urinary incontinence in women: a review[J]. JAMA, 2017, 318(16): 1592-1604.
[14] Parsons J K, Mougey J, Lambert L, et al. Lower urinary tract symptoms increase the risk of falls in older men[J]. BJU Int, 2009, 104(1): 63-68.
[15] Sandhu J S, Bixler B R, Dahm P, et al. Management of lower urinary tract symptoms attributed to benign prostatic hyperplasia (BPH): AUA guideline amendment 2023[J]. J Urol, 2024, 211(1): 11-19.
[16] DeWitt-Foy M E, Elliott S P. Neurogenic bladder: assessment and operative management[J]. Urol Clin North Am, 2022, 49(3): 519-532.
[17] Yang Z C, Lin H, Jiang G H, et al. Frailty is a risk factor for falls in the older adults: a systematic review and meta-analysis[J]. J Nutr Health Aging, 2023, 27(6): 487-495.
[18] Xu Q, Ou X, Li J. The risk of falls among the aging population: a systematic review and meta-analysis[J]. Front Public Health, 2022, 10: 902599.
[19] Major M J. Fall prevalence and contributors to the likelihood of falling in persons with upper limb loss[J]. Phys Ther, 2019, 99(4): 377-387.
[20] Clemens S, Gaunaurd I, Raya M, et al. Using theoretical frameworks to examine fall history and associated prosthetic mobility in people with nondysvascular lower limb amputation[J]. Prosthet Orthot Int, 2022, 46(5): 484-490.
[21] Mol A, Bui Hoang P T S, Sharmin S, et al. Orthostatic hypotension and falls in older adults: a systematic review and meta-analysis[J]. J Am Med Dir Assoc, 2019, 20(5): 589-597.e5.
[22] Luo Y, Miyawaki C E, Valimaki M A, et al. Symptoms of anxiety and depression predicting fall-related outcomes among older Americans: a longitudinal study[J]. BMC Geriatr, 2022, 22(1): 749.
[23] Gambaro E, Gramaglia C, Azzolina D, et al. The complex associations between late life depression, fear of falling and risk of falls: a systematic review and meta-analysis[J]. Ageing Res Rev, 2022, 73: 101532.
[24] Clemson L, Stark S, Pighills A C, et al. Environmental interventions for preventing falls in older people living in the community[J]. Cochrane Database Syst Rev, 2023, 3(3): CD013258.
[25] Jiang Y, Xia Q, Zhou P, et al. Environmental hazards increase the fall risk among residents of long-term care facilities: a prospective study in Shanghai, China[J]. Age Ageing, 2021, 50(3): 875-881.
[26] Shao L, Shi Y, Xie X Y, et al. Incidence and risk factors of falls among older people in nursing homes: systematic review and meta-analysis[J]. J Am Med Dir Assoc, 2023, 24(11): 1708-1717.
[27] Kim I J, Hegazy F. Enhancing footwear safety for fall prevention in older adults: a comprehensive review of design features[J]. Ann Geriatr Med Res, 2024, 28(2): 121-133.
[28] Ganz D A, Huang C, Saliba D, et al. Preventing falls in hospitals: a toolkit for improving quality of care[R/OL]. 2013. https://www.ahrq.gov/sites/default/files/publications/files/fallpxtoolkit_0.pdf.
[29] Barker A L, Morello R T, Wolfe R, et al. 6-PACK programme to decrease fall injuries in acute hospitals: cluster randomised controlled trial[J]. BMJ, 2016, 352: h6781.
[30] Sherrington C, Fairhall N J, Wallbank G K, et al. Exercise for preventing falls in older people living in the community[J]. Cochrane Database Syst Rev, 2019, 1(1): CD012424.
[31] Li F, Harmer P, Fitzgerald K, et al. Effectiveness of a therapeutic Tai Ji Quan intervention vs a multimodal exercise intervention to prevent falls among older adults at high risk of falling: a randomized clinical trial[J]. JAMA Intern Med, 2018, 178(10): 1301-1310.
[32] Winstein C J, Stein J, Arena R, et al. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association[J]. Stroke, 2016, 47(6): e98-e169.
[33] Osborne J A, Botkin R, Colon-Semenza C, et al. Physical therapist management of Parkinson disease: a clinical practice guideline from the American Physical Therapy Association[J]. Phys Ther, 2022, 102(4): pzab302.
[34] You J S, Kim Y L, Lee S M. Effects of a standard transfer exercise program on transfer quality and activities of daily living for transfer-dependent spinal cord injury patients[J]. J Phys Ther Sci, 2017, 29(3): 478-483.
[35] Oelke M, De Wachter S, Drake M J, et al. A practical approach to the management of nocturia[J]. Int J Clin Pract, 2017, 71(11): e13027.
[36] Nguyen L N, Randhawa H, Nadeau G, et al. Canadian Urological Association best practice report: diagnosis and management of nocturia[J]. Can Urol Assoc J, 2022, 16(7): E336-E349.
[37] Cameron A P, Chung D E, Dielubanza E J, et al. The AUA/SUFU guideline on the diagnosis and treatment of idiopathic overactive bladder[J]. J Urol, 2024, 212(1): 11-20.
[38] Liao L, Li X, Chong T, et al. Efficacy and safety of tibial nerve stimulation using a wearable device for overactive bladder[J]. BJU Int, 2024, 133(6): 760-769.
[39] Mikuš M, Kalafatic D, Vrbanic A, et al. Efficacy comparison between Kegel exercises and extracorporeal magnetic innervation in treatment of female stress urinary incontinence: a randomized clinical trial[J]. Medicina (Kaunas), 2022, 58(12): 1863.
[40] Liao L, Zhou Z, Chen G, et al. Sacral neuromodulation using a novel device with a six-contact-point electrode for the treatment of patients with refractory overactive bladder: a multicenter, randomized, single-blind, parallel-control clinical trial[J]. Eur Urol Focus, 2022, 8(6): 1823-1830.
[41] 中华医学会泌尿外科学分会尿控学组. 肉毒毒素治疗下尿路功能障碍中国专家共识[J]. 中华泌尿外科杂志, 2021, 42(6): 405-410.
[42] Freire L B, Brasil-Neto J P, da Silva M L, et al. Risk factors for falls in older adults with diabetes mellitus: systematic review and meta-analysis[J]. BMC Geriatr, 2024, 24(1): 201.
[43] Camicioli R, Morris M E, Pieruccini-Faria F, et al. Prevention of falls in Parkinson’s disease: guidelines and gaps[J]. Mov Disord Clin Pract, 2023, 10(10): 1459-1469.
[44] Stubbs B, Binnekade T, Eggermont L, et al. Pain and the risk for falls in community-dwelling older adults: systematic review and meta-analysis[J]. Arch Phys Med Rehabil, 2014, 95(1): 175-187.e9.
[45] 2023 American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults[J]. J Am Geriatr Soc, 2023, 71(7): 2052-2081.
[46] Woolcott J C, Richardson K J, Wiens M O, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons[J]. Arch Intern Med, 2009, 169(21): 1952-1960.
[47] Lee J, Negm A, Peters R, et al. Deprescribing fall-risk increasing drugs (FRIDs) for the prevention of falls and fall-related complications: a systematic review and meta-analysis[J]. BMJ Open, 2021, 11(2): e035978.
[48] Ming Y, Zecevic A A, Hunter S W, et al. Medication review in preventing older adults’ fall-related injury: a systematic review and meta-analysis[J]. Can Geriatr J, 2021, 24(3): 237-250.
[49] Chua C H M, Jiang Y, Lim S, et al. Effectiveness of cognitive behaviour therapy-based multicomponent interventions on fear of falling among community-dwelling older adults: a systematic review and meta-analysis[J]. J Adv Nurs, 2019, 75(12): 3299-3315.
[50] Wetherell J L, Johnson K, Chang D, et al. Activity, balance, learning, and exposure (ABLE): a new intervention for fear of falling[J]. Int J Geriatr Psychiatry, 2016, 31(7): 791-798.
[51] Thölking T W, Lamers E C T, Olde Rikkert M G M. A guiding nightlight decreases fear of falling and increases sleep quality of community-dwelling older people: a quantitative and qualitative evaluation[J]. Gerontology, 2020, 66(3): 295-303.
[52] Warrington D J, Shortis E J, Whittaker P J. Are wearable devices effective for preventing and detecting falls: an umbrella review[J]. BMC Public Health, 2021, 21(1): 2091.
[53] Lee K, Kim S, Lee J, et al. Effects of community-based fall prevention interventions for older adults using information and communication technology: a systematic review and meta-analysis[J]. Health Informatics J, 2024, 30(3): 14604582241259324.
[54] Dykes P C, Burns Z, Adelman J, et al. Evaluation of a patient-centered fall-prevention tool kit to reduce falls and injuries: a nonrandomized controlled trial[J]. JAMA Netw Open, 2020, 3(11): e2025889.
[55] Heng H, Jazayeri D, Shaw L, et al. Hospital falls prevention with patient education: a scoping review[J]. BMC Geriatr, 2020, 20(1): 140.
[56] Cameron I D, Dyer S M, Panagoda C E, et al. Interventions for preventing falls in older people in care facilities and hospitals[J]. Cochrane Database Syst Rev, 2018, 9(9): CD005465.
[57] Almeida A S, Paguia A, Neves A P. Nursing interventions to empower family caregivers to manage the risk of falling in older adults: a scoping review[J]. Int J Environ Res Public Health, 2024, 21(3): 246.
[58] Albasha N, Curtin C, McCullagh R, et al. Staff's insights into fall prevention solutions in long-term care facilities: a cross-sectional study[J]. BMC Geriatr, 2023, 23(1): 738.
[59] Hawkins M, Goldhammer T, McClave R, et al. Evaluation of a fall prevention program to reduce fall risk and fear of falling among community-dwelling older adults and adults with disabilities[J]. Clin Interv Aging, 2024, 19: 375-383.

基金

国家重点研发计划“主动健康和人口老龄化科技应对”重点专项(2023YFC3605300;2023YFC3605305)

PDF(1219 KB)

Accesses

Citation

Detail

段落导航
相关文章

/

〈 〉