Objective Systematically review and critically appraise the evidence for the association between delirium and falls in community-dwelling adults aged ≥60 years. Methods We searched EMBASE, MEDLINE, PsycINFO, Cochrane Database of Systematic Reviews, CINAHL and Evidence-Based Medicine Reviews databases in April 2023. Standard methods were used to screen, extract data, assess risk of bias (using Newcastle–Ottawa scale), provide a narrative synthesis and, where appropriate, conduct meta-analysis. Results We included 8 studies, with at least 3505 unique participants. Five found limited evidence for an association between delirium and subsequent falls: one adjusted study showed an increase in falls (risk ratio 6.66; 95% confidence interval (CI) 2.16–20.53), but the evidence was low certainty. Four non-adjusted studies found no clear effect. Three studies (one with two subgroups treated separately) found some evidence for an association between falls and subsequent delirium: meta-analysis of three adjusted studies showed an increase in delirium (pooled odds ratio 2.01; 95% CI 1.52–2.66); one subgroup of non-adjusted data found no clear effect. Number of falls and fallers were reported in the studies. Four studies and one subgroup were at high risk of bias and one study had some concerns. Conclusions We found limited evidence for the association between delirium and falls. More methodologically rigorous research is needed to understand the complex relationship and establish how and why this operates bidirectionally. Studies must consider confounding factors such as dementia, frailty and comorbidity in their design, to identify potential modifying factors involved. Clinicians should be aware of the potential relationship between these common presentations.

中文翻译：

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社区老年人谵妄与跌倒之间的关联：系统评价和荟萃分析


目的 系统回顾和批判性评价 60 岁社区成人谵妄与跌倒≥相关性的证据。方法 我们于 2023 年 4 月检索了 EMBASE、MEDLINE、PsycINFO、Cochrane 系统综述数据库、CINAHL 和循证医学综述数据库。使用标准方法筛选、提取数据、评估偏倚风险（使用 Newcastle-Ottawa 量表）、提供叙述性综合，并在适当的情况下进行荟萃分析。结果我们纳入了 8 项研究，至少有 3505 名独特的受试者。五项研究发现谵妄与后续跌倒之间存在关联的有限证据：一项调整后的研究显示跌倒增加（风险比 6.66;95% 置信区间 （CI） 2.16-20.53），但证据质量低。四项未经调整的研究发现没有明显的效果。三项研究（一项分别处理两个亚组）发现了一些证据表明跌倒与随后的谵妄之间存在关联：对三项调整研究的荟萃分析显示谵妄增加（合并比值比 2.01;95% CI 1.52-2.66）;一个未校正数据的亚组发现没有明显的效应。研究中报告了跌倒和跌倒的数量。四项研究和一项亚组存在高偏倚风险，一项研究存在一些担忧。结论 我们发现谵妄与跌倒之间关联的证据有限。需要更严格的方法论研究来理解这种复杂的关系，并确定它如何以及为什么是双向运作的。研究必须在其设计中考虑混杂因素，如痴呆、虚弱和合并症，以确定所涉及的潜在修饰因素。临床医生应了解这些常见表现之间的潜在关系。